Provider Demographics
NPI:1851754899
Name:RITCHIE, MARK ALLEN (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:RITCHIE
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 1:33636 VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:LONE ROCK
Mailing Address - State:WI
Mailing Address - Zip Code:53556-4168
Mailing Address - Country:US
Mailing Address - Phone:715-401-1999
Mailing Address - Fax:
Practice Address - Street 1:1313 W SEMINARY ST
Practice Address - Street 2:200
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2067
Practice Address - Country:US
Practice Address - Phone:608-647-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001334 - 15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist