MEDICARE: DR. ANDREW BADEO HOCKLEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	20955	TX

General Provider Information

NPI Number	:	1144206830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW BADEO HOCKLEY DDS

Provider Business Mailing Address
First Line	:	19906 WILD CRST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78266-2251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19906 WILD CRST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78266-2251
Country	:	US
Telephone Number	:	210-464-2016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	10/01/2012

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