Provider Demographics
NPI:1265451744
Name:ROONEY, GEORGE EUGENE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EUGENE
Last Name:ROONEY
Suffix:JR
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 1:18230 LE CHATEAU DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4922
Mailing Address - Country:US
Mailing Address - Phone:262-786-7959
Mailing Address - Fax:
Practice Address - Street 1:11711 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3108
Practice Address - Country:US
Practice Address - Phone:414-771-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000-942-0151223P0700X
IL122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0700XDental ProvidersDentistProsthodontics
Not Answered122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33414800Medicaid