Provider Demographics
NPI:1104440296
Name:TROUT, LUCAS IAN (DDS)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:IAN
Last Name:TROUT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2208
Mailing Address - Country:US
Mailing Address - Phone:574-583-8060
Mailing Address - Fax:
Practice Address - Street 1:210 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2208
Practice Address - Country:US
Practice Address - Phone:574-583-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013348A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist