MEDICARE: MARTIN E STOCKER 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	19148	TX

General Provider Information

NPI Number	:	1962422758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN E STOCKER DDS

Provider Business Mailing Address
First Line	:	1721 W 35TH ST
Second Line	:	A
City	:	AUSTIN
State	:	TX
Zip	:	78703-1320
Country	:	US
Telephone Number	:	512-476-1922
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 W 35TH ST
Second Line	:	A
City	:	AUSTIN
State	:	TX
Zip	:	78703-1320
Country	:	US
Telephone Number	:	512-476-1922
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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Directions to “ MARTIN E STOCKER DDS” Practice Location

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