Provider Demographics
NPI:1174687933
Name:RITER, HOLLI (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOLLI
Middle Name:
Last Name:RITER
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:LLUSD SPECIAL CARE DENTISTRY
Mailing Address - Street 2:11092 ANDERSON ST.
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0001
Mailing Address - Country:US
Mailing Address - Phone:909-558-4611
Mailing Address - Fax:909-558-0106
Practice Address - Street 1:LLUSD SPECIAL CARE DENTISTRY
Practice Address - Street 2:11092 ANDERSON ST.
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0001
Practice Address - Country:US
Practice Address - Phone:909-558-4611
Practice Address - Fax:909-558-0106
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45315OtherDENTAL LICENSE