Individual
DESIREE C STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7223 MISSISSIPPI AVE., FORT POLK, LA 71459
(337) 531-2603
Mailing address
7223 MISSISSIPPI AVE, FORT POLK, LA 71459
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
04/11/2023
Last updated
04/11/2023
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