=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467727602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARWOOD STOUT, DDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2012
-----------------------------------------------------
Last Update Date | 03/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 SOLAR DR #291
-----------------------------------------------------
City | OXNARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-981-8144
-----------------------------------------------------
Fax | 805-981-8146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1701 SOLAR DR. #291
-----------------------------------------------------
City | OXNARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-981-8144
-----------------------------------------------------
Fax | 805-981-8146
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARWOOD M STOUT
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 805-981-8144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 36787
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------