Individual
DR. RYLLIS A ROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1615 TRUEMPER ST, LACKLAND A F B, TX 78236-5511
(210) 292-6385
(210) 292-5211
Mailing address
2200 BERGQUIST DR STE 1, ATTN: CREDENTIALS (CMC), LACKLAND A F B, TX 78236-9908
(210) 292-6385
(210) 292-5211
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
4462
AL
Other
Enumeration date
07/31/2006
Last updated
07/08/2007
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