MEDICARE: DR. ALFRED KENNETH STOCKIN DDS DENTIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4153	NC
2	1223G0001X	General Practice Dentistry	DN 6511	FL

General Provider Information

NPI Number	:	1003907288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED KENNETH STOCKIN DDS DENTIST

Provider Business Mailing Address
First Line	:	3535 RANDOLPH ROAD
Second Line	:	SUITE 200 RANDOLPH MEDICAL PARK
City	:	CHARLOTTE
State	:	NC
Zip	:	28211
Country	:	US
Telephone Number	:	704-364-1191
Fax Number	:	704-364-1185

Provider Business Practice Location Address
First Line	:	3535 RANDOLPH ROAD
Second Line	:	SUITE 200 RANDOLPH MEDICAL PARK
City	:	CHARLOTTE
State	:	NC
Zip	:	28211
Country	:	US
Telephone Number	:	704-364-1191
Fax Number	:	704-364-1185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ALFRED KENNETH STOCKIN DDS DENTIST” Practice Location

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