Healthcare Provider Details

I. General information

NPI: 1326252719
Provider Name (Legal Business Name): SMILING BUCKEYE ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/27/2008
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 Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN HOCKENBERGER
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 330-825-7060