Provider Demographics
NPI:1295301091
Name:STOCK, MICHAEL (DDS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
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 1:7511 REED ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4815
Mailing Address - Country:US
Mailing Address - Phone:712-202-3260
Mailing Address - Fax:
Practice Address - Street 1:7564 HIGHWAY 72 W STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9437
Practice Address - Country:US
Practice Address - Phone:256-690-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210198601223G0001X
ALD-0007122-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty