Provider Demographics
NPI:1245917442
Name:RITCHIE, DALLIN (DMD)
Entity type:Individual
Prefix:DR
First Name:DALLIN
Middle Name:
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 1:793 E WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7564
Mailing Address - Country:US
Mailing Address - Phone:801-849-1045
Mailing Address - Fax:801-304-3151
Practice Address - Street 1:5089 W 12600 S
Practice Address - Street 2:UNIT 3
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-2599
Practice Address - Country:US
Practice Address - Phone:801-748-0379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13442580-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice