MEDICARE: DR. JAMES W STOCKTON DDS

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	9976	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BLUE CROSS BLUE SHIE	OTHER	MN	BLUE CROSS ID NUMBER
2	710609	OTHER	MN	UNITED OF CONCORDIA ID #

General Provider Information

NPI Number	:	1063486256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES W STOCKTON DDS

Provider Business Mailing Address
First Line	:	2010 27TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1108
Country	:	US
Telephone Number	:	612-336-8478
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 27TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1108
Country	:	US
Telephone Number	:	612-336-8478
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/09/2007

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