Provider Demographics
NPI:1508947326
Name:STOCKBURGER, DANIEL GUY (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GUY
Last Name:STOCKBURGER
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 1:3834 KECOUGHTAN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4402
Mailing Address - Country:US
Mailing Address - Phone:757-727-7726
Mailing Address - Fax:757-727-0925
Practice Address - Street 1:3834 KECOUGHTAN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4402
Practice Address - Country:US
Practice Address - Phone:757-727-7726
Practice Address - Fax:757-727-0925
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014115231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice