Organization Name: | THERON A. STOUT D.D.S. |
NPI Number: | 1174951727 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THERON A. STOUT (OWNER) |
Mailing Address: | 8310 Morro Rd Atascadero |
State: | CA US |
Postal Code: | 934223927 |
Phone Number: | 8056020402 |
Fax Number: | |
NPI Enumeration Date: | 10/17/2013 |
NPI Last Update Date: | 10/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 50103 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |