Provider Demographics
NPI:1497746168
Name:STOCK, DAWN ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ELLEN
Last Name:STOCK
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 1:141 CAMINO ALTO
Mailing Address - Street 2:STE 4
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2246
Mailing Address - Country:US
Mailing Address - Phone:415-389-8520
Mailing Address - Fax:415-389-0243
Practice Address - Street 1:141 CAMINO ALTO
Practice Address - Street 2:STE 4
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2246
Practice Address - Country:US
Practice Address - Phone:415-389-8520
Practice Address - Fax:415-389-0243
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice