Provider Demographics
NPI:1679785125
Name:STOCKTON, RANDALL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:K
Last Name:STOCKTON
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 1:1330 SE 4TH AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1958
Mailing Address - Country:US
Mailing Address - Phone:954-463-6110
Mailing Address - Fax:954-463-6116
Practice Address - Street 1:1330 SE 4TH AVE
Practice Address - Street 2:SUITE L
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1958
Practice Address - Country:US
Practice Address - Phone:954-463-6110
Practice Address - Fax:954-463-6116
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL73321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice