MEDICARE: DR. STEPHEN JAMES ROUSE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	2816	NC

General Provider Information

NPI Number	:	1366407363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN JAMES ROUSE DMD

Provider Business Mailing Address
First Line	:	309 S SHARON AMITY RD STE 306
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2886
Country	:	US
Telephone Number	:	704-366-2001
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 S SHARON AMITY RD STE 306
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2886
Country	:	US
Telephone Number	:	704-366-2001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/08/2007

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