MEDICARE: DR. KENNETH EDWARD HOECKER 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	018025	OH

General Provider Information

NPI Number	:	1487745667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH EDWARD HOECKER DDS

Provider Business Mailing Address
First Line	:	P.O. BOX 280
Second Line	:	820 W.MAIN ST
City	:	HEBRON
State	:	OH
Zip	:	43025
Country	:	US
Telephone Number	:	740-928-4596
Fax Number	:	740-928-0761

Provider Business Practice Location Address
First Line	:	820 W MAIN ST
Second Line	:
City	:	HEBRON
State	:	OH
Zip	:	43025-9033
Country	:	US
Telephone Number	:	740-928-4596
Fax Number	:	740-928-0761

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	05/28/2013

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