Provider Demographics
NPI:1902814882
Name:RITCHIE, KIRK R (DDS)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:R
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:PO BOX 396
Mailing Address - Street 2:5409 EVERYBODYS ROAD FOREST COUNTY POTAWATOMI HEALTH &
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520
Mailing Address - Country:US
Mailing Address - Phone:715-478-4300
Mailing Address - Fax:715-478-4490
Practice Address - Street 1:5409 EVERYBODYS ROAD
Practice Address - Street 2:FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520
Practice Address - Country:US
Practice Address - Phone:715-478-4300
Practice Address - Fax:715-478-4490
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4113015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33704300Medicaid
WI74434OtherSECURITY HEALTH PLAN