Healthcare Provider Details

I. General information

NPI: 1316935570
Provider Name (Legal Business Name): DAVID A ROUGEUX DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3934 DIXIE HWY SUITE 430
LOUISVILLE KY
40216-4163
US

IV. Provider business mailing address

3934 DIXIE HWY 430
LOUISVILLE KY
40216-4163
US

V. Phone/Fax

Practice location:
  • Phone: 502-449-1723
  • Fax: 502-448-7488
Mailing address:
  • Phone: 502-449-1723
  • Fax: 502-448-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6253
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6253
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: