Provider Demographics
NPI:1235118274
Name:RITTER, MARK ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:RITTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 MOUNTAIN LAUREL CT
Mailing Address - Street 2:
Mailing Address - City:WARRIORS MARK
Mailing Address - State:PA
Mailing Address - Zip Code:16877-6411
Mailing Address - Country:US
Mailing Address - Phone:814-632-6852
Mailing Address - Fax:
Practice Address - Street 1:846 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:PA
Practice Address - Zip Code:16611-2936
Practice Address - Country:US
Practice Address - Phone:814-669-9004
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019615L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice