Provider Demographics
NPI:1609391655
Name:STEPHEN STROUT, DMD, MS
Entity Type:Organization
Organization Name:STEPHEN STROUT, DMD, MS
Other - Org Name:ST. AUGUSTINE CENTER FOR DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:LOVE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-323-5293
Mailing Address - Street 1:1301 PLANTATION ISLAND DR S STE 204
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3111
Mailing Address - Country:US
Mailing Address - Phone:904-794-1824
Mailing Address - Fax:904-794-4584
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 204
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3111
Practice Address - Country:US
Practice Address - Phone:904-794-1824
Practice Address - Fax:904-794-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty