Provider Demographics
NPI:1619404514
Name:STOUT, ALYSSA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:R
Last Name:STOUT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:R
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5219 LANKFORD HWY
Mailing Address - Street 2:
Mailing Address - City:NEW CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:23415-3332
Mailing Address - Country:US
Mailing Address - Phone:757-824-5676
Mailing Address - Fax:
Practice Address - Street 1:5219 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:NEW CHURCH
Practice Address - State:VA
Practice Address - Zip Code:23415-3332
Practice Address - Country:US
Practice Address - Phone:757-824-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
VA0401416060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program