Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11077 | TN |
N | 126800000X | Dental Assistant |
NPI | 1093375321 |
---|---|
Provider Name | Dr. James D Ritter |
First Address | Bartlett, TN 38133-2751 |
Second Address | Cordova, TN 38018-4262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2019 |
Last Update Date | 03/09/2019 |