Provider Demographics
NPI:1821186842
Name:ROUSSALIS, JOHN ELIAS II (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELIAS
Last Name:ROUSSALIS
Suffix:II
Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:1216 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2927
Mailing Address - Country:US
Mailing Address - Phone:307-234-8555
Mailing Address - Fax:307-234-8555
Practice Address - Street 1:1216 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2927
Practice Address - Country:US
Practice Address - Phone:307-234-8555
Practice Address - Fax:307-234-8555
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WYWY 5841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics