Organization
THERON A. STOUT, DDS A PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THERON ANDREW STOUT DDS (PRESIDENT/PEDIATRIC DENTIST)
(805) 464-2723
Entity
Organization
Contact information
Practice address
8310 MORRO RD., ATASCADERO, CA 93422-3927
(805) 464-2723
(805) 464-2726
Mailing address
8310 MORRO RD, ATASCADERO, CA 93422-3927
(805) 464-2723
(805) 464-2726
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
50103
CA
Other
Enumeration date
10/17/2013
Last updated
10/18/2022
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