Provider Demographics
NPI:1619315454
Name:PELTON, RITCHIE S (D M D)
Entity Type:Individual
Prefix:DR
First Name:RITCHIE
Middle Name:S
Last Name:PELTON
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 N PARK PLACE ST
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6373
Mailing Address - Country:US
Mailing Address - Phone:801-830-0760
Mailing Address - Fax:
Practice Address - Street 1:1834 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-8109
Practice Address - Country:US
Practice Address - Phone:801-224-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8692315-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice