Individual
LANCE SCOTT RITCHIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
480 N LATAH ST, BOISE, ID 83706-2630
(208) 345-8962
Mailing address
480 N LATAH ST, BOISE, ID 83706-2630
(208) 345-8962
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4066
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807762900
—
ID
Enumeration date
06/18/2007
Last updated
07/29/2008
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