Provider Demographics
NPI:1629150701
Name:RITCHIE, DONALD PEARSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PEARSON
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 1:6733 HIGHLANDS COURT
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703
Mailing Address - Country:US
Mailing Address - Phone:903-531-9000
Mailing Address - Fax:903-531-9006
Practice Address - Street 1:6733 HIGHLANDS COURT
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703
Practice Address - Country:US
Practice Address - Phone:903-531-9000
Practice Address - Fax:903-531-9006
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163024603Medicaid
TX163113702Medicaid
TX1767965OtherUNITED CONCORDIA