MEDICARE: DR. CYNTHIA QUINN STOCKWELL 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	14003	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	B14003	OTHER	TX	TX CHIPS DELTA DENTAL

General Provider Information

NPI Number	:	1982731279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA QUINN STOCKWELL DDS

Provider Business Mailing Address
First Line	:	303 NOBHILL DRIVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1729
Country	:	US
Telephone Number	:	210-432-7778
Fax Number	:

Provider Business Practice Location Address
First Line	:	378 LAS PALMAS DRIVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-3108
Country	:	US
Telephone Number	:	210-432-7778
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	06/10/2021

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