Healthcare Provider Details

I. General information

NPI: 1700856515
Provider Name (Legal Business Name): TRENTINGTON LANE OUTHOUSE DDS, MS, FAGD, ABGD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NBHC, NSA, ASU, BAH PSC 451 BOX 340
FPO AE
09834-2800
BH

IV. Provider business mailing address

NBHC, NSA, ASU, BAH PSC 451 BOX 340
FPO AE
09834-2800
BH

V. Phone/Fax

Practice location:
  • Phone: 01197339607621
  • Fax:
Mailing address:
  • Phone: 01197339607621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number52796
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4980
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: