MEDICARE: MARIA C HOEKSTRA DDS FAGD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901013039	MI

General Provider Information

NPI Number	:	1528240744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA C HOEKSTRA DDS FAGD

Provider Business Mailing Address
First Line	:	1121 OTTAWA BEACH ROAD
Second Line	:	SUITE 100
City	:	HOLLAND
State	:	MI
Zip	:	49424-2567
Country	:	US
Telephone Number	:	616-399-9520
Fax Number	:	616-399-0945

Provider Business Practice Location Address
First Line	:	1121 OTTAWA BEACH ROAD
Second Line	:	SUITE 100
City	:	HOLLAND
State	:	MI
Zip	:	49424-2567
Country	:	US
Telephone Number	:	616-399-9520
Fax Number	:	616-399-0945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	11/29/2007

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