Provider Demographics
NPI:1326242603
Name:ROUD, TARAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:TARAS
Middle Name:
Last Name:ROUD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 SOUTHSHORE BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-333-2522
Mailing Address - Fax:561-333-2484
Practice Address - Street 1:12300 SOUTHSHORE BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-333-2522
Practice Address - Fax:561-333-2484
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics