Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5799 | NC |
NPI | 1013006741 |
---|---|
Provider Name | Dr. Marcella C. Sockwell |
First Address | Oxford, NC 27565-1142 |
Second Address | Oxford, NC 27565-3559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 23/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5799 | LICENSE NUMBER (01) | NC |
91694 | BCBSNC PROVIDER ID NUMBER (01) | NC |