Provider Demographics
NPI:1033398458
Name:TROUT, CARL A (DDS)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:TROUT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2538 UNIVERSITY DR S
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5714
Mailing Address - Country:US
Mailing Address - Phone:701-232-1148
Mailing Address - Fax:701-232-8907
Practice Address - Street 1:2538 UNIVERSITY DR S
Practice Address - Street 2:SUITE A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5714
Practice Address - Country:US
Practice Address - Phone:701-232-1148
Practice Address - Fax:701-232-8907
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND21681223P0221X
NE67341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40116Medicaid