Provider Demographics
NPI:1659440451
Name:STOCKTON, DALE A (DMD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:A
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LAKE WASHINGTON RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3400
Mailing Address - Country:US
Mailing Address - Phone:321-259-0217
Mailing Address - Fax:
Practice Address - Street 1:2900 LAKE WASHINGTON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3400
Practice Address - Country:US
Practice Address - Phone:321-259-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL140731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593660327OtherTIN