Organization
STOCKTON FAMILY & COSMETIC DENTISTRY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLYDE STOCKTON (PRESIDENT)
(803) 735-9446
Entity
Organization
Contact information
Practice address
5219 TWO NOTCH RD, COLUMBIA, SC 29204
(803) 735-9446
(803) 735-9813
Mailing address
5219 TWO NOTCH RD, COLUMBIA, SC 29204
(803) 735-9446
(803) 735-9813
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1967
SC
1223G0001X
General Practice Dentistry
3901
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z19677
—
SC
Enumeration date
10/13/2006
Last updated
06/02/2008
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