Provider Demographics
NPI:1770612012
Name:RITTER, SAMUEL VAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:VAN
Last Name:RITTER
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:PO BOX 1421
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-1421
Mailing Address - Country:US
Mailing Address - Phone:662-869-2100
Mailing Address - Fax:662-869-0069
Practice Address - Street 1:105 TOWN CREEK DR
Practice Address - Street 2:SUITE A
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-7947
Practice Address - Country:US
Practice Address - Phone:662-869-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3266-03122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist