Provider Demographics
NPI:1811163033
Name:ROUSSEAU, CHARLES MORGAN (D M D)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MORGAN
Last Name:ROUSSEAU
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 HUGHES RD
Mailing Address - Street 2:STE 4
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8959
Mailing Address - Country:US
Mailing Address - Phone:256-464-3556
Mailing Address - Fax:256-464-3553
Practice Address - Street 1:540 HUGHES RD
Practice Address - Street 2:STE 4
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:256-464-3556
Practice Address - Fax:256-464-3553
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1851498059OtherORGANIZATIONAL NPI