Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2168 | ND |
N | 1223P0221X | Pediatric Dentist | 6734 | NE |
NPI | 1033398458 |
---|---|
Provider Name | Carl A Trout |
First Address | Fargo, ND 58103-5714 |
Second Address | Fargo, ND 58103-5714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2007 |
Last Update Date | 10/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40116 | (05) | ND |