Healthcare Provider Details

I. General information

NPI: 1942984448
Provider Name (Legal Business Name): KIRSTEN ROUSE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 HIGHLAND AVE
FORT THOMAS KY
41075-1746
US

IV. Provider business mailing address

637 HIGHLAND AVE
FORT THOMAS KY
41075-1746
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-2662
  • Fax:
Mailing address:
  • Phone: 859-781-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD-00170
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: