Provider Demographics
NPI:1568477891
Name:RITZ, MARY L (DDS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:RITZ
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 1:10325 RIDGECREST PT
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9600
Mailing Address - Country:US
Mailing Address - Phone:724-934-8403
Mailing Address - Fax:
Practice Address - Street 1:TORRANCE STATE HOSPITAL
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:PA
Practice Address - Zip Code:15779-0111
Practice Address - Country:US
Practice Address - Phone:724-459-4401
Practice Address - Fax:724-459-4465
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025166L122300000X
VA0401008391122300000X
MD10832 (INACTIVE)122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABR3343833OtherDEA