Healthcare Provider Details

I. General information

NPI: 1194577239
Provider Name (Legal Business Name): COLE E RITZEMA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 HUGHES DR JOBST TOWER, 6TH FLOOR
TOLEDO OH
43606
US

IV. Provider business mailing address

150 LOCUST LN
CADILLAC MI
49601-9732
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-7222
  • Fax:
Mailing address:
  • Phone: 231-878-9647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES.005015
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: