Provider Demographics
NPI:1043230865
Name:RITTLER, ROBERT DOUGLAS (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:RITTLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:
Other - Last Name:RITTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4949 PLEASANT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1741
Mailing Address - Country:US
Mailing Address - Phone:515-222-1852
Mailing Address - Fax:
Practice Address - Street 1:4949 PLEASANT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1741
Practice Address - Country:US
Practice Address - Phone:515-222-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA65751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17109OtherFEDERAL WELLMARK
IA0171090Medicaid
IA708956OtherUNITED CONCORDIA