Provider Demographics
NPI:1316935570
Name:ROUGEUX, DAVID A (DMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ROUGEUX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 DIXIE HWY
Mailing Address - Street 2:430
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4163
Mailing Address - Country:US
Mailing Address - Phone:502-449-1723
Mailing Address - Fax:502-448-7488
Practice Address - Street 1:3934 DIXIE HWY
Practice Address - Street 2:SUITE 430
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4163
Practice Address - Country:US
Practice Address - Phone:502-449-1723
Practice Address - Fax:502-448-7488
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62531223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4581Medicaid