1700856515 NPI number — TRENTINGTON LANE OUTHOUSE DDS, MS, FAGD, ABGD

NPI Number: 1700856515
Health Care Provider/Practitioner: TRENTINGTON LANE OUTHOUSE DDS, MS, FAGD, ABGD

NPI Number : 1700856515 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700856515",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OUTHOUSE",
    "FirstName": "TRENTINGTON",
    "MiddleName": "LANE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS, MS, FAGD, ABGD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "NBHC, NSA, ASU, BAH",
    "SecondLineMailingAddress": "PSC 451 BOX 340",
    "MailingAddressCityName": "FPO",
    "MailingAddressStateName": "AE",
    "MailingAddressPostalCode": "09834-2800",
    "MailingAddressCountryCode": "BH",
    "MailingAddressTelephoneNumber": "01197339607621",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "NBHC, NSA, ASU, BAH",
    "SecondLinePracticeLocationAddress": "PSC 451 BOX 340",
    "PracticeLocationAddressCityName": "FPO",
    "PracticeLocationAddressStateName": "AE",
    "PracticeLocationAddressPostalCode": "09834-2800",
    "PracticeLocationAddressCountryCode": "BH",
    "PracticeLocationAddressTelephoneNumber": "01197339607621",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/24/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "52796",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "4980",
          "LicenseNumberStateCode": "LA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}