Provider Demographics
NPI:1649050196
Name:STOUTE, DIANA CLAIRE (RDH, BSDH)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:CLAIRE
Last Name:STOUTE
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 JONES BRIDGE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-8017
Mailing Address - Country:US
Mailing Address - Phone:504-908-7407
Mailing Address - Fax:
Practice Address - Street 1:1018 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4037
Practice Address - Country:US
Practice Address - Phone:423-639-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10430124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist