Provider Demographics
NPI:1538235767
Name:STOCKDALE, ROBERT C (DDS MS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:STOCKDALE
Suffix:
Gender:M
Credentials:DDS MS
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Other - Credentials:
Mailing Address - Street 1:9080 MILLIKEN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5558
Mailing Address - Country:US
Mailing Address - Phone:909-373-4898
Mailing Address - Fax:909-373-4899
Practice Address - Street 1:3487 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2115
Practice Address - Country:US
Practice Address - Phone:951-369-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA307161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics