Kevin Jude Rourk, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15647 Issued in MI

Practice address

1200 S Detroit Ave
Toledo VA Cboc
Toledo, OH 43614-5903

Phone

(419) 351-5583

NPI assigned

Jul 28, 2007

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

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

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": "1185580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460160000000",
    "number": "1992995690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S DETROIT AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436145903",
            "telephone_number": "419-351-5583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S DETROIT AVE",
            "address_2": "TOLEDO VA CBOC",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436145903",
            "telephone_number": "419-351-5583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROURK",
        "first_name": "KEVIN",
        "middle_name": "JUDE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-28",
        "last_updated": "2016-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "15647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Roundtree, QMHS
• Michelle Roundtree
• Pamela Faye Roundtree
• Rakeia Roundtree, INDEPENDENT PROVIDER
• Shavellory Latrice Roundtree
• Cassandra Rousos, QMHS
• Sandra Gwen Rousseau, RN
• Farrah F Routon
• Konner Joshua Routon
• Helisa Deborah Rowan

• General Practice Dentistry in Toledo, OH
• Providers in Toledo, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2016; 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.