Dominique D. Rousson, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

MA 17814 Issued in MA

Practice address

1001 Watertown St.
West Newton, MA 02465

Phone

(617) 965-1321

Fax

(617) 965-2412

NPI assigned

Aug 21, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154437408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 WATETOWN ST",
            "city": "WEST NEWTON",
            "state": "MA",
            "postal_code": "02465",
            "telephone_number": "617-965-1321",
            "fax_number": "617-965-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 WATERTOWN ST.",
            "city": "WEST NEWTON",
            "state": "MA",
            "postal_code": "02465",
            "telephone_number": "617-965-1321",
            "fax_number": "617-965-2412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSSON",
        "first_name": "DOMINIQUE",
        "middle_name": "D.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "MA 17814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LIC#",
            "identifier": "MA 17814",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter Rider, DMD
• Amanda Rose Rodrigues, ATC
• Dan H Rome, M.D.
• Michelle L Roover, LICSW, MS
• Miriam Louise Ross, LICSW
• Rhonda Natanblut Ruby, M.S.
• Sarah Horn, Licsw
• Diane Sartanowicz, ATC, LAT
• Scandinavian Charitable Society of Greater Boston
• Phoebe Kazdin Schnitzer, PHD

• Dentist in West Newton, MA
• Providers in West Newton, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.