Provider Demographics
NPI:1376661397
Name:RITOLA, KEVIN SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SCOTT
Last Name:RITOLA
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 1:11903 NE 128TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7209
Mailing Address - Country:US
Mailing Address - Phone:425-820-0900
Mailing Address - Fax:425-823-2528
Practice Address - Street 1:11903 NE 128TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7209
Practice Address - Country:US
Practice Address - Phone:425-820-0900
Practice Address - Fax:425-823-2528
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA76221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice