Provider Demographics
NPI:1861451171
Name:STOCK, CHRISTOPHER RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RAYMOND
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 1:2006 MANATEE AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-5856
Mailing Address - Country:US
Mailing Address - Phone:941-748-7017
Mailing Address - Fax:941-746-1056
Practice Address - Street 1:2006 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5856
Practice Address - Country:US
Practice Address - Phone:941-748-7017
Practice Address - Fax:941-746-1056
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN155011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65-1142450OtherTAX ID