Provider Demographics
NPI:1568575066
Name:ROUSH, EUGENE DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:DONALD
Last Name:ROUSH
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:RADISSON
Mailing Address - State:WI
Mailing Address - Zip Code:54867-0008
Mailing Address - Country:US
Mailing Address - Phone:715-945-2901
Mailing Address - Fax:715-945-2805
Practice Address - Street 1:3661 N HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:RADISSON
Practice Address - State:WI
Practice Address - Zip Code:54867-7067
Practice Address - Country:US
Practice Address - Phone:715-945-2901
Practice Address - Fax:715-945-2805
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2853-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice