Provider Demographics
NPI:1457564536
Name:ROBERT B. ROURKE D.D.S., P.S.
Entity Type:Organization
Organization Name:ROBERT B. ROURKE D.D.S., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-852-7331
Mailing Address - Street 1:10920 SE 208TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-4009
Mailing Address - Country:US
Mailing Address - Phone:253-852-7331
Mailing Address - Fax:253-813-3826
Practice Address - Street 1:10920 SE 208TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-4009
Practice Address - Country:US
Practice Address - Phone:253-852-7331
Practice Address - Fax:253-813-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000046681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty