Provider Demographics
NPI:1306150818
Name:RITZAU, KRISTEN LEILANI (DDS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEILANI
Last Name:RITZAU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 AVENIDA CABRILLO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4039
Mailing Address - Country:US
Mailing Address - Phone:949-498-4110
Mailing Address - Fax:949-498-8657
Practice Address - Street 1:122 AVENIDA CABRILLO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4039
Practice Address - Country:US
Practice Address - Phone:949-498-4110
Practice Address - Fax:949-498-8657
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice