Provider Demographics
NPI:1568873032
Name:CARL A. TROUT, DDS, PC
Entity Type:Organization
Organization Name:CARL A. TROUT, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:1701-232-1148
Mailing Address - Street 1:2538 UNIVERSITY DR S
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5714
Mailing Address - Country:US
Mailing Address - Phone:170-123-2114
Mailing Address - Fax:
Practice Address - Street 1:2538 UNIVERSITY DR S
Practice Address - Street 2:SUITE A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5714
Practice Address - Country:US
Practice Address - Phone:170-123-2114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2168261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000040116Medicaid