Provider Demographics
NPI:1669685137
Name:SIDNEY W. SOCKWELL,DDS, PA
Entity Type:Organization
Organization Name:SIDNEY W. SOCKWELL,DDS, PA
Other - Org Name:DRS. MARCELLA & SID SOCKWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:WM
Authorized Official - Last Name:SOCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-693-8922
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:111 EAST INDUSTRY DRIVE
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-1142
Mailing Address - Country:US
Mailing Address - Phone:919-693-8922
Mailing Address - Fax:
Practice Address - Street 1:111 E INDUSTRY DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3559
Practice Address - Country:US
Practice Address - Phone:919-693-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5799OtherLICENSE NUMBER
NC91694OtherBCBS PROVIDER ID NUMBER
NC97978OtherBCBS PROVIDER ID NUMBER
NC156887OtherUNITED CONCORDIA PROVIDER
NC5850OtherLICENSE NUMBER