Provider Demographics
NPI:1063486256
Name:STOCKTON, JAMES W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 27TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1108
Mailing Address - Country:US
Mailing Address - Phone:612-336-8478
Mailing Address - Fax:
Practice Address - Street 1:2010 27TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1108
Practice Address - Country:US
Practice Address - Phone:612-336-8478
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN99761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNBLUE CROSS BLUE SHIEOtherBLUE CROSS ID NUMBER
MN710609OtherUNITED OF CONCORDIA ID #