Provider Demographics
NPI:1588896385
Name:RITZEMA FAMILY DENTAL, P.C.
Entity type:Organization
Organization Name:RITZEMA FAMILY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RITZEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-775-5381
Mailing Address - Street 1:8795 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9777
Mailing Address - Country:US
Mailing Address - Phone:231-775-5381
Mailing Address - Fax:231-775-9801
Practice Address - Street 1:8795 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-9777
Practice Address - Country:US
Practice Address - Phone:231-775-5381
Practice Address - Fax:231-775-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010165021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty