Healthcare Provider Details

I. General information

NPI: 1770890071
Provider Name (Legal Business Name): CHARLES ROBERT STOCKS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W BULLARD AVE #106
CLOVIS CA
93612-0861
US

IV. Provider business mailing address

255 W BULLARD AVE STE 106
CLOVIS CA
93612-0861
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-3384
  • Fax: 559-298-3443
Mailing address:
  • Phone: 559-298-3384
  • Fax: 559-298-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number25452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: