Provider Demographics
NPI:1174732549
Name:RITTER, STEPHANIE A (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:RITTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 ELK DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6661
Mailing Address - Country:US
Mailing Address - Phone:701-837-1050
Mailing Address - Fax:701-837-6350
Practice Address - Street 1:2615 ELK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-1200
Practice Address - Country:US
Practice Address - Phone:701-837-1050
Practice Address - Fax:701-837-6350
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-01-26
Deactivation Date:2015-04-13
Deactivation Code:
Reactivation Date:2016-01-26
Provider Licenses
StateLicense IDTaxonomies
ND19821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND949343OtherDENTAL SERVICE CORP
ND41394Medicaid