Provider Demographics
NPI:1457493025
Name:RITCHIE, DAVID COBURN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:COBURN
Last Name:RITCHIE
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 1:1022 E STUART DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2512
Mailing Address - Country:US
Mailing Address - Phone:276-236-4925
Mailing Address - Fax:276-236-9703
Practice Address - Street 1:1022 E STUART DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2512
Practice Address - Country:US
Practice Address - Phone:276-236-4925
Practice Address - Fax:276-236-9703
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice