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William Stout Dental, PLLC

Company Details

Name: William Stout Dental, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 05 Nov 2024 (7 months ago)
Financial Date End: 30 Nov 2025
Entity Number: 5965427
Place of Formation: IDAHO
File Number: 962452
ZIP code: 83440
County: Madison County
Principal Address: SUITE E & F 286 E MOODY ROAD REXBURG, ID 83440
Mailing Address: DR. WILLIAM STOUT STE E 286 E MOODY RD REXBURG, ID 83440-5566

Agent

Name Role Address
William Craig Stout Agent 286 MOODY ROAD, SUITE E, REXBURG, ID 83440

National Provider Identifier

NPI Number:
1912716507
Certification Date:
2025-01-07

Authorized Person:

Name:
DR. WILLIAM CRAIG STOUT
Role:
DOCTOR/OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QD0000X - Dental Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0005965427 2024-11-05

Date of last update: 23 May 2025

Sources: Idaho Secretary of State