Provider Demographics
NPI:1740876168
Name:LUCAS IAN TROUT, DDS, LLC
Entity type:Organization
Organization Name:LUCAS IAN TROUT, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-748-0809
Mailing Address - Street 1:6535 E 175 N
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-7488
Mailing Address - Country:US
Mailing Address - Phone:765-748-0809
Mailing Address - Fax:
Practice Address - Street 1:210 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2208
Practice Address - Country:US
Practice Address - Phone:765-748-0809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental