Provider Demographics
NPI:1760454912
Name:STOCK, ROGER ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALLEN
Last Name:STOCK
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 1:5303 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-2864
Mailing Address - Country:US
Mailing Address - Phone:614-866-8111
Mailing Address - Fax:614-866-0634
Practice Address - Street 1:5303 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2864
Practice Address - Country:US
Practice Address - Phone:614-866-8111
Practice Address - Fax:614-866-0634
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0123451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice