Healthcare Provider Details

I. General information

NPI: 1487749172
Provider Name (Legal Business Name): RITCHIE L HIBBERT, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SOUTHGATE SUITE 3
PENDLETON OR
97801-3974
US

IV. Provider business mailing address

1100 SOUTHGATE SUITE 3
PENDLETON OR
97801-3974
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-5272
  • Fax: 541-276-7212
Mailing address:
  • Phone: 541-276-5272
  • Fax: 541-276-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD5957
License Number StateOR

VIII. Authorized Official

Name: DR. RITCHIE L HIBBERT
Title or Position: PRESIDENT
Credential: DMD
Phone: 541-276-5272