Basic Information
| Provider Information | |||||||||
| NPI: | 1326528100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOUT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10472 ROCKINGHAM DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956705826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165440431 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2465 IRON POINT RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956308754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169849600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DDS103054 | CA | Y | Dental Providers | Dentist |
No ID Information.