Provider Demographics
NPI:1093981532
Name:STOCKMAN, KRISTIN CORNELLA (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:CORNELLA
Last Name:STOCKMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 TELFORD LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4427
Mailing Address - Country:US
Mailing Address - Phone:919-367-8007
Mailing Address - Fax:
Practice Address - Street 1:102 TELFORD LN
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4427
Practice Address - Country:US
Practice Address - Phone:919-367-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist