Provider Demographics
NPI:1578613360
Name:ROUSH, DAVID BARTHOLOMEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BARTHOLOMEW
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 1:3502 SW H K DODGEN LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6859
Mailing Address - Country:US
Mailing Address - Phone:254-770-1010
Mailing Address - Fax:254-771-2120
Practice Address - Street 1:3502 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6859
Practice Address - Country:US
Practice Address - Phone:254-770-1010
Practice Address - Fax:254-771-2120
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice