Provider Demographics
NPI:1851810188
Name:STOCKELL, AGNES T (DMD)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:T
Last Name:STOCKELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-3014
Mailing Address - Country:US
Mailing Address - Phone:949-413-4090
Mailing Address - Fax:
Practice Address - Street 1:5060 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-3014
Practice Address - Country:US
Practice Address - Phone:949-413-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041481122300000X
CA108649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist