Individual
DR. BRADSHAW M STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
719 BAYSHORE DR, NICEVILLE, FL 32578-2527
(850) 240-1455
Mailing address
209 SWEETWATER RUN, NICEVILLE, FL 32578-1637
(850) 714-7373
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN29633
FL
1223P0300X
Periodontics
Primary
DN29633
FL
Other
Enumeration date
11/03/2005
Last updated
10/02/2024
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