Provider Demographics
NPI:1073624052
Name:RITTENBERG, HARRIS L (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:L
Last Name:RITTENBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5417 ORTEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8417
Mailing Address - Country:US
Mailing Address - Phone:904-384-4391
Mailing Address - Fax:904-389-0806
Practice Address - Street 1:5417 ORTEGA BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8417
Practice Address - Country:US
Practice Address - Phone:904-384-4391
Practice Address - Fax:904-389-0806
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice