Healthcare Provider Details

I. General information

NPI: 1487745667
Provider Name (Legal Business Name): KENNETH EDWARD HOECKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W MAIN ST
HEBRON OH
43025-9033
US

IV. Provider business mailing address

P.O. BOX 280 820 W.MAIN ST
HEBRON OH
43025
US

V. Phone/Fax

Practice location:
  • Phone: 740-928-4596
  • Fax: 740-928-0761
Mailing address:
  • Phone: 740-928-4596
  • Fax: 740-928-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number018025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: