Provider Demographics
NPI:1619954013
Name:ROUNDS, BRIAN KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KENT
Last Name:ROUNDS
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 5983
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-5983
Mailing Address - Country:US
Mailing Address - Phone:360-491-5880
Mailing Address - Fax:
Practice Address - Street 1:1407 COLLEGE ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2655
Practice Address - Country:US
Practice Address - Phone:360-491-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051469122300000X
WADE60030651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist