Provider Demographics
NPI:1831250471
Name:RITZEMA, BRUCE EDWIN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EDWIN
Last Name:RITZEMA
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 1:825 W. US-10
Mailing Address - Street 2:
Mailing Address - City:SCOTTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49454
Mailing Address - Country:US
Mailing Address - Phone:231-757-4722
Mailing Address - Fax:231-757-9554
Practice Address - Street 1:825 W. US-10
Practice Address - Street 2:
Practice Address - City:SCOTTVILLE
Practice Address - State:MI
Practice Address - Zip Code:49454
Practice Address - Country:US
Practice Address - Phone:231-757-4722
Practice Address - Fax:231-757-9554
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI144591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice