Provider Demographics
NPI:1912716507
Name:WILLIAM STOUT DENTAL PLLC
Entity type:Organization
Organization Name:WILLIAM STOUT DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-551-9963
Mailing Address - Street 1:286 E MOODY RD STE E&F
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-5566
Mailing Address - Country:US
Mailing Address - Phone:509-551-9963
Mailing Address - Fax:
Practice Address - Street 1:286 E MOODY RD STE E&F
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5566
Practice Address - Country:US
Practice Address - Phone:509-551-9963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental