MEDICARE: DR. HARRIS L RITTENBERG D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10140	FL

General Provider Information

NPI Number	:	1073624052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRIS L RITTENBERG D.M.D.

Provider Business Mailing Address
First Line	:	5417 ORTEGA BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-8417
Country	:	US
Telephone Number	:	904-384-4391
Fax Number	:	904-389-0806

Provider Business Practice Location Address
First Line	:	5417 ORTEGA BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-8417
Country	:	US
Telephone Number	:	904-384-4391
Fax Number	:	904-389-0806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. HARRIS L RITTENBERG D.M.D.” Practice Location

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