Provider Demographics
NPI:1023144029
Name:RETTIG, RICHARD H (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:RETTIG
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 1:224 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:TRIPOLI
Mailing Address - State:IA
Mailing Address - Zip Code:50676-0065
Mailing Address - Country:US
Mailing Address - Phone:319-882-3555
Mailing Address - Fax:319-882-3107
Practice Address - Street 1:224 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:TRIPOLI
Practice Address - State:IA
Practice Address - Zip Code:50767-0065
Practice Address - Country:US
Practice Address - Phone:319-882-3555
Practice Address - Fax:319-882-3107
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1184952Medicaid