Individual provider Active NPI

Donald Pearson Ritchie, D.D.S.

  • Pediatric Dentistry
  • Tyler, TX
National Provider Identifier
1629150701
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
21602 Issued in TX
Practice address
6733 Highlands Court
Tyler, TX 75703
Phone
(903) 531-9000
Fax
(903) 531-9006
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 21602 TX Primary

Addresses

Primary practice location

6733 Highlands Court
Tyler, TX 75703

Mailing address

6733 Highlands Court
Tyler, TX 75703
Phone (903) 531-9000

Other practice location 1

2301 S Broadway Ave
Suite B-10
Tyler, TX 75701-5402
Phone (903) 531-9000

Other identifiers 3

IdentifierTypeStateIssuer
163024603MedicaidTX
163113702MedicaidTX
1767965OtherTXUNITED CONCORDIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
21602TXMDPediatric Dentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1629150701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6733 HIGHLANDS COURT",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75703",
            "telephone_number": "903-531-9000",
            "fax_number": "903-531-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6733 HIGHLANDS COURT",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75703",
            "telephone_number": "903-531-9000",
            "fax_number": "903-531-9006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 S Broadway Ave",
            "address_2": "Suite B-10",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757015402",
            "country_code": "US",
            "telephone_number": "903-531-9000",
            "fax_number": "903-531-9006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RITCHIE",
        "first_name": "DONALD",
        "middle_name": "PEARSON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "21602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163024603",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163113702",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1767965",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.