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General NPI Number Information
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NPI Number | 1841976842
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Entity Type | Individual
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Provider Name | PARKER ROUSTIO DMD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 1002 E WESLEY DR STE 200
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City | O FALLON
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State | IL
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Zip | 62269-6143
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Country | US
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Telephone | 618-628-7080
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Fax | 618-628-9235
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Provider Business Mailing Address
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Address Line | 8422 BRAESWOOD ESTATES DR
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City | O FALLON
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State | IL
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Zip | 62269-4247
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.034489
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License Number State | IL
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