Healthcare Provider Details

I. General information

NPI: 1033323415
Provider Name (Legal Business Name): BRIAN HOCKENBERGER DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 CLEVELAND MASSILLON RD SUITE A
NORTON OH
44203-5732
US

IV. Provider business mailing address

4312 CLEVELAND MASSILLON RD SUITE A
NORTON OH
44203-5732
US

V. Phone/Fax

Practice location:
  • Phone: 330-825-7060
  • Fax: 330-825-5190
Mailing address:
  • Phone: 330-825-7060
  • Fax: 330-825-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number19782
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: