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General NPI Number Information
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NPI Number | 1730307240
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Entity Type | Individual
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Provider Name | JONATHAN GOOLD STROUT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 46 MALLETT DR
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City | FREEPORT
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State | ME
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Zip | 04032-1313
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Country | US
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Telephone | 207-865-3934
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Fax | 207-865-4590
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Provider Business Mailing Address
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Address Line | PO BOX 276
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City | BRUNSWICK
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State | ME
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Zip | 04011-0276
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Country | US
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Telephone | 207-729-7788
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2896
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License Number State | ME
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