Healthcare Provider Details

I. General information

NPI: 1972575579
Provider Name (Legal Business Name): MICHAEL S TROUT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 HILL ST
COLUMBIA SC
29207-6022
US

IV. Provider business mailing address

4323 HILL ST
COLUMBIA SC
29207-6022
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-6213
  • Fax: 803-751-6886
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12009925A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: