Provider Demographics
NPI:1003907288
Name:STOCKIN, ALFRED KENNETH (DDS DENTIST)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:KENNETH
Last Name:STOCKIN
Suffix:
Gender:M
Credentials:DDS DENTIST
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:STOCKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS DENTIST
Mailing Address - Street 1:3535 RANDOLPH ROAD
Mailing Address - Street 2:SUITE 200 RANDOLPH MEDICAL PARK
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:704-364-1191
Mailing Address - Fax:704-364-1185
Practice Address - Street 1:3535 RANDOLPH ROAD
Practice Address - Street 2:SUITE 200 RANDOLPH MEDICAL PARK
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-364-1191
Practice Address - Fax:704-364-1185
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41531223G0001X
FLDN 65111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice