Provider Demographics
NPI:1720391303
Name:BRIAN K ROUNDS, DDS,PLLC
Entity Type:Organization
Organization Name:BRIAN K ROUNDS, DDS,PLLC
Other - Org Name:ALPINE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-915-7350
Mailing Address - Street 1:1407 COLLEGE ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2655
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60030651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty