Provider Demographics
NPI:1851459911
Name:RITTER, MELISSA MORGAN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MORGAN
Last Name:RITTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:LEIGH
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4436 BROUSSARD ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808
Mailing Address - Country:US
Mailing Address - Phone:225-927-1934
Mailing Address - Fax:
Practice Address - Street 1:2960 E GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461
Practice Address - Country:US
Practice Address - Phone:985-641-3988
Practice Address - Fax:985-646-2536
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1853488Medicaid