Provider Demographics
NPI:1669766945
Name:STOUT, EMILY MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MARIE
Last Name:STOUT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 WATERBURY PARK DR
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-2390
Mailing Address - Country:US
Mailing Address - Phone:574-293-9222
Mailing Address - Fax:
Practice Address - Street 1:805 WATERBURY PARK DR
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-2390
Practice Address - Country:US
Practice Address - Phone:574-293-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011619A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice