Individual
DOMINIQUE D. ROUSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1001 WATERTOWN ST., WEST NEWTON, MA 02465
(617) 965-1321
(617) 965-2412
Mailing address
1001 WATETOWN ST, WEST NEWTON, MA 02465
(617) 965-1321
(617) 965-2412
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
MA 17814
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA 17814
DENTAL LIC#
MA
Enumeration date
08/21/2006
Last updated
07/08/2007
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