Organization
BRANT ROUSE DDS PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANT PHILIP ROUSE DDS (PRESIDENT)
(918) 456-0977
Entity
Organization
Contact information
Practice address
559 MEADOW CREEK DRIVE, TAHLEQUAH, OK 74464-1088
(918) 456-0977
(855) 856-5958
Mailing address
559 MEADOW CREEK DRIVE, TAHLEQUAH, OK 74464-1088
(918) 456-0977
(855) 856-5958
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200081330A
—
OK
Enumeration date
03/29/2010
Last updated
08/07/2020
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