Provider Demographics
NPI:1457418204
Name:VITTER, ROGER A (MD, MED)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:VITTER
Suffix:
Gender:M
Credentials:MD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 HOUMA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3000
Mailing Address - Country:US
Mailing Address - Phone:504-883-3737
Mailing Address - Fax:504-883-3777
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3000
Practice Address - Country:US
Practice Address - Phone:504-883-3737
Practice Address - Fax:504-883-3777
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA37461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics