Provider Demographics
NPI:1851854723
Name:RITTER, GAGE EVANS (DDS)
Entity Type:Individual
Prefix:
First Name:GAGE
Middle Name:EVANS
Last Name:RITTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16606 WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:IOWA
Mailing Address - State:LA
Mailing Address - Zip Code:70647-6343
Mailing Address - Country:US
Mailing Address - Phone:337-912-5176
Mailing Address - Fax:
Practice Address - Street 1:4243 AMBASSADOR CAFFERY PKWY STE 118
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7268
Practice Address - Country:US
Practice Address - Phone:337-422-3587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist