Provider Demographics
NPI:1487697579
Name:STOCKINGER, JOHN PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:STOCKINGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3471
Mailing Address - Country:US
Mailing Address - Phone:262-691-3193
Mailing Address - Fax:262-691-3193
Practice Address - Street 1:131 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3471
Practice Address - Country:US
Practice Address - Phone:262-691-3193
Practice Address - Fax:262-691-3193
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice