Provider Demographics
NPI:1215119615
Name:MELISSA K STOCKTON, DOM, P.C.
Entity type:Organization
Organization Name:MELISSA K STOCKTON, DOM, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:STOCKTON
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-888-6208
Mailing Address - Street 1:6208 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1400
Mailing Address - Country:US
Mailing Address - Phone:505-888-6208
Mailing Address - Fax:505-888-3011
Practice Address - Street 1:6208 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE F
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1400
Practice Address - Country:US
Practice Address - Phone:505-888-6208
Practice Address - Fax:505-888-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM593171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty