Provider Demographics
NPI: | 1841217668 |
---|---|
Name: | LLOYD K. RITCHIE, JR., DDS, PA |
Entity Type: | Organization |
Organization Name: | LLOYD K. RITCHIE, JR., DDS, PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | DIANE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RITCHIE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 850-494-2292 |
Mailing Address - Street 1: | 9320 N PALAFOX ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PENSACOLA |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32534-3040 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 850-494-2292 |
Mailing Address - Fax: | 850-494-6613 |
Practice Address - Street 1: | 9320 N PALAFOX ST |
Practice Address - Street 2: | |
Practice Address - City: | PENSACOLA |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32534-3040 |
Practice Address - Country: | US |
Practice Address - Phone: | 850-494-2292 |
Practice Address - Fax: | 850-494-6613 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-16 |
Last Update Date: | 2008-05-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | DN0011681 | 261QD0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |