Provider Demographics
NPI:1639272503
Name:WILSON, RITCHIE LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RITCHIE
Middle Name:LYNN
Last Name:WILSON
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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-0250
Mailing Address - Country:US
Mailing Address - Phone:205-631-9806
Mailing Address - Fax:
Practice Address - Street 1:210 REDMAYNE RD
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2405
Practice Address - Country:US
Practice Address - Phone:205-631-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice