Organization
MARTHA V. ROUSSEL, DDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTHA VANDERSYPEN ROUSSEL DDS (DENTIST)
(225) 603-0590
Entity
Organization
Contact information
Practice address
8220 GOODWOOD BLVD STE 4B, BATON ROUGE, LA 70806-7741
(225) 603-0590
Mailing address
39450 QUAIL CREEK AVE, PRAIRIEVILLE, LA 70769-4829
(225) 603-0590
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5276
LA
Other
Enumeration date
06/14/2007
Last updated
06/16/2008
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