Provider Demographics
NPI:1881661049
Name:STOUT, BOYD LUWAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOYD
Middle Name:LUWAYNE
Last Name:STOUT
Suffix:
Gender:M
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:PO BOX 6
Mailing Address - Street 2:11 HOSPITAL WAY
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-0006
Mailing Address - Country:US
Mailing Address - Phone:509-689-2557
Mailing Address - Fax:509-689-3179
Practice Address - Street 1:11 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-0006
Practice Address - Country:US
Practice Address - Phone:509-689-2557
Practice Address - Fax:509-689-3179
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2510340071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5379003Medicare ID - Type Unspecified