Provider Demographics
NPI:1700856515
Name:OUTHOUSE, TRENTINGTON LANE (DDS, MS, FAGD, ABGD)
Entity Type:Individual
Prefix:DR
First Name:TRENTINGTON
Middle Name:LANE
Last Name:OUTHOUSE
Suffix:
Gender:M
Credentials:DDS, MS, FAGD, ABGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NBHC, NSA, ASU, BAH
Mailing Address - Street 2:PSC 451 BOX 340
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09834-2800
Mailing Address - Country:BH
Mailing Address - Phone:0119733-960-7621
Mailing Address - Fax:
Practice Address - Street 1:NBHC, NSA, ASU, BAH
Practice Address - Street 2:PSC 451 BOX 340
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09834-2800
Practice Address - Country:BH
Practice Address - Phone:0119733-960-7621
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527961223G0001X
LA49801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice