Desiree C Stout

NPI #1215622642 in Fort Polk, Louisiana

Provider Information

NPI Number: 1215622642
Entity Type: Individual
Name: Desiree C Stout
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dental Assistant
Enumeration Date: Apr 11, 2023
Last Updated: Apr 11, 2023

Practice Location

Address: 7223 MISSISSIPPI AVE.
City: Fort Polk
State: Louisiana
ZIP Code: 71459
Phone: (337) 531-2603

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Hygienist	124Q00000X
Dental Assistant	126800000X	Primary

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