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General NPI Number Information
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NPI Number | 1366756728
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Entity Type | Individual
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Provider Name | JOSEPH RYAN STOUT DDS
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Gender | Male
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 651 SE MAYLOR ST
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City | OAK HARBOR
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State | WA
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Zip | 98277-5413
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Country | US
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Telephone | 206-427-2514
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 282
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City | COUPEVILLE
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State | WA
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Zip | 98239-0282
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60292936
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DR 60168161
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License Number State | WA
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