Provider Demographics
NPI:1982208799
Name:GITOMER, RALPH (DDS)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:GITOMER
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 1:1530 12TH ST N APT 506
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3656
Mailing Address - Country:US
Mailing Address - Phone:703-528-6818
Mailing Address - Fax:
Practice Address - Street 1:1530 12TH ST N APT 506
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-3656
Practice Address - Country:US
Practice Address - Phone:703-528-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7013122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist