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General NPI Number Information
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NPI Number | 1912716507
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Entity Type | Organization
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Legal Business Name | WILLIAM STOUT DENTAL PLLC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 286 E MOODY RD STE E&F
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City | REXBURG
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State | ID
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Zip | 83440-5566
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Country | US
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Telephone | 509-551-9963
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Fax |
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Provider Business Mailing Address
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Address Line | 286 E MOODY RD STE E&F
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City | REXBURG
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State | ID
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Zip | 83440-5566
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Country | US
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Telephone | 509-551-9963
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. WILLIAM CRAIG STOUT
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Credential | DDS
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Telephone | 509-551-9963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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