Provider Demographics
NPI:1164560629
Name:TOUTANT, CAROL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:TOUTANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20620 N PARK BLVD
Mailing Address - Street 2:218
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4519
Mailing Address - Country:US
Mailing Address - Phone:216-932-4330
Mailing Address - Fax:
Practice Address - Street 1:20620 N PARK BLVD
Practice Address - Street 2:218
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4519
Practice Address - Country:US
Practice Address - Phone:216-932-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30. 0169571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0819118Medicaid