Basic Information
| Provider Information | |||||||||
| NPI: | 1437107356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RITTER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 15TH ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309120004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037516209 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4323 HILL ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292076022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037516209 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0700X | 019-019104 | IL | Y | Dental Providers | Dentist | Prosthodontics |
ID Information
| ID | Type | State | Issuer | Description | 019-019104 | 01 | IL | ILLINOIS DENTAL LICENSE | OTHER | DNF000423 | 01 | GA | GEORGIA FACULTY LICENSE | OTHER |