Provider Demographics
NPI:1548406739
Name:ROUSE, LEO E (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:E
Last Name:ROUSE
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 1:2213 DURBIN CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2817
Mailing Address - Country:US
Mailing Address - Phone:301-925-0081
Mailing Address - Fax:202-806-0354
Practice Address - Street 1:DIXON BUILDING HOWARD UNIVERSITY COLLEGE OF
Practice Address - Street 2:600 W STREET, N.W. OFFICE OF THE DEAN
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20059-0001
Practice Address - Country:US
Practice Address - Phone:202-806-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN5905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist