Provider Demographics
NPI:1023351228
Name:RITZ, MICHAEL
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 IBM RD STE C&D
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-463-9300
Mailing Address - Fax:845-463-3035
Practice Address - Street 1:10 IBM RD STE C&D
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5436
Practice Address - Country:US
Practice Address - Phone:845-463-9300
Practice Address - Fax:845-463-3035
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051334-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice