Individual
MR. JONATHAN DUANE STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
145 NE 3RD ST, MCMINNVILLE, OR 97128-4900
(503) 472-0990
Mailing address
145 NE 3RD ST, MCMINNVILLE, OR 97128-4900
(503) 472-0990
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-302894
RI
Other
Enumeration date
03/16/2007
Last updated
07/08/2007
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