=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912121112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCEAN DENTAL OF OHIO, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3646 E. MAIN STREET
-----------------------------------------------------
City | WHITEHALL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-231-4800
-----------------------------------------------------
Fax | 614-231-4801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 W. SIXTH AVE
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74074-4017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-707-0600
-----------------------------------------------------
Fax | 405-707-0602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHAD B. HOECKER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 405-707-0600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------