Healthcare Provider Details

I. General information

NPI: 1437107356
Provider Name (Legal Business Name): RICHARD V. RITTER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 HILL ST
COLUMBIA SC
29207-6022
US

IV. Provider business mailing address

1120 15TH ST
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-6209
  • Fax:
Mailing address:
  • Phone: 803-751-6209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number019-019104
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: