Individual
PAUL J ROUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
15024 MARTIN LUTHER KING JR BLVD, GULFPORT, MS 39501
(228) 863-9781
(228) 864-8553
Mailing address
544 MAGNOLIA DR N, WIGGINS, MS 39577-3236
(601) 928-5711
(601) 928-7712
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
179077
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0060456
—
MS
Enumeration date
03/16/2006
Last updated
05/22/2014
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