Theron a. Stout, DDS a Professional Dental Corporation

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

50103 Issued in CA

Legal business name

THERON A. STOUT, DDS A PROFESSIONAL DENTAL CORPORATION

Practice address

8310 Morro Rd.
Atascadero, CA 93422-3927

Phone

(805) 464-2723

Fax

(805) 464-2726

NPI assigned

Oct 17, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Theron Andrew Stout, DDSNPI 1417173980

Title

President/Pediatric Dentist

Phone

(805) 464-2723

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theron Andrew Stout, DDS

  • Pediatric Dentistry
  • Atascadero, CA
  • NPI 1417173980
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1174951727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8310 MORRO RD",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934223927",
            "telephone_number": "805-464-2723",
            "fax_number": "805-464-2726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8310 MORRO RD.",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934223927",
            "telephone_number": "805-464-2723",
            "fax_number": "805-464-2726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERON A. STOUT, DDS A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-17",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "THERON",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT/PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "805-464-2723",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "50103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Tesoro, M.A., LMFT
• Jeffrey Franz Teuber, PHD
• Richard Michael Teubner, L.C.S.W.
• Stacy Leigh Thacker, PHD
• The Plateroti Center for Holistic Wellness
• Thrifty Payless Inc
• Timothy N Tidwell, MD
• Lily Liou Tinkle, MD
• Sara Elizabeth Todaro
• Marilyn Gail Tonneson, MFT

• Pediatric Dentistry in Atascadero, CA
• Providers in Atascadero, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.