| Organization Name: | KRISTEN RITZAU DDS, INC. |
| NPI Number: | 1043640915 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KRISTEN RITZAU (OWNER) |
| Mailing Address: | 122 Avenida Cabrillo San Clemente |
| State: | CA US |
| Postal Code: | 926724039 |
| Phone Number: | 9494984110 |
| Fax Number: | 9494988657 |
| NPI Enumeration Date: | 11/13/2013 |
| NPI Last Update Date: | 11/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 59541 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |