=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386708469
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL P HOCHSTATTER DR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 E JOE DR SUITE 120
-----------------------------------------------------
City | AMBOY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61310-9492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-857-2015
-----------------------------------------------------
Fax | 815-857-2333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 110
-----------------------------------------------------
City | AMBOY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61310-0110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-857-2015
-----------------------------------------------------
Fax | 815-857-2333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------