Healthcare Provider Details

I. General information

NPI: 1457418204
Provider Name (Legal Business Name): ROGER A VITTER M.D., M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 HOUMA BLVD SUITE 210
METAIRIE LA
70006-3000
US

IV. Provider business mailing address

4228 HOUMA BLVD SUITE 210
METAIRIE LA
70006-3000
US

V. Phone/Fax

Practice location:
  • Phone: 504-883-3737
  • Fax: 504-883-3777
Mailing address:
  • Phone: 504-883-3737
  • Fax: 504-883-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3746
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: