Provider Demographics
NPI:1801819313
Name:STOCK, KEVIN TURNER (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TURNER
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 1:2200 PARK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2186
Mailing Address - Country:US
Mailing Address - Phone:208-678-8188
Mailing Address - Fax:208-678-3170
Practice Address - Street 1:2200 PARK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2186
Practice Address - Country:US
Practice Address - Phone:208-678-8188
Practice Address - Fax:208-678-3170
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD19861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice