Provider Demographics
NPI:1053586362
Name:ROOKSBERRY, DONNIE WAYNE (DDS MS)
Entity type:Individual
Prefix:
First Name:DONNIE
Middle Name:WAYNE
Last Name:ROOKSBERRY
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3963
Mailing Address - Country:US
Mailing Address - Phone:219-924-1440
Mailing Address - Fax:219-922-8856
Practice Address - Street 1:1630 45TH AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3963
Practice Address - Country:US
Practice Address - Phone:219-924-1440
Practice Address - Fax:219-922-8856
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007014A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics