Provider Demographics
NPI:1487617676
Name:QUOCK, STANLEY LEONG (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LEONG
Last Name:QUOCK
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 1:53 NOONAN RANCH CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8064
Mailing Address - Country:US
Mailing Address - Phone:707-332-7988
Mailing Address - Fax:
Practice Address - Street 1:53 NOONAN RANCH CIR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8064
Practice Address - Country:US
Practice Address - Phone:707-332-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278211223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice