Provider Demographics
NPI:1801576327
Name:RITZ, DANIEL JOHN (DMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:RITZ
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 1:314 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-2058
Mailing Address - Country:US
Mailing Address - Phone:570-899-8867
Mailing Address - Fax:
Practice Address - Street 1:375 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5528
Practice Address - Country:US
Practice Address - Phone:570-283-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0442471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice