Provider Demographics
NPI:1205941523
Name:STOCKER, JON C (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:C
Last Name:STOCKER
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 1:244 GOLDEN LN
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-2279
Mailing Address - Country:US
Mailing Address - Phone:419-222-8856
Mailing Address - Fax:419-222-2321
Practice Address - Street 1:244 GOLDEN LN
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2279
Practice Address - Country:US
Practice Address - Phone:419-222-8856
Practice Address - Fax:419-222-2321
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0191981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice