Provider Demographics
NPI:1750088324
Name:JOSEPH STOUT DDS PLLC
Entity type:Organization
Organization Name:JOSEPH STOUT DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-427-2514
Mailing Address - Street 1:1081 SW THORNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7249
Mailing Address - Country:US
Mailing Address - Phone:206-427-2514
Mailing Address - Fax:
Practice Address - Street 1:651 SE MAYLOR ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5413
Practice Address - Country:US
Practice Address - Phone:360-675-4613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental