Provider Demographics
NPI:1982731279
Name:STOCKWELL, CYNTHIA QUINN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:QUINN
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 NOBHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1729
Mailing Address - Country:US
Mailing Address - Phone:210-432-7778
Mailing Address - Fax:
Practice Address - Street 1:378 LAS PALMAS DRIVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3108
Practice Address - Country:US
Practice Address - Phone:210-432-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008627401Medicaid
TXB14003OtherTX CHIPS DELTA DENTAL