Healthcare Provider Details

I. General information

NPI: 1033112099
Provider Name (Legal Business Name): JOHN JEFFREY HOCKEMA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12036 N MICHIGAN RD STE 200
ZIONSVILLE IN
46077-8782
US

IV. Provider business mailing address

10972 ALLISONVILLE RD SUITE 110
FISHERS IN
46038-2637
US

V. Phone/Fax

Practice location:
  • Phone: 317-733-0926
  • Fax: 317-733-0950
Mailing address:
  • Phone: 317-913-2363
  • Fax: 317-913-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12009020A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: