MEDICARE: OCEAN DENTAL OF INDIANA, P.C.

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

General Provider Information

NPI Number	:	1578737854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN DENTAL OF INDIANA, P.C.

Provider Business Mailing Address
First Line	:	206 W 6TH AVE
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74074-4017
Country	:	US
Telephone Number	:	405-707-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 LAFAYETTE RD
Second Line	:	SUITE J
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5443
Country	:	US
Telephone Number	:	317-280-1447
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHAD BRANDON HOECKER
Credential	:	DDS
Telephone Number	:	405-707-0600

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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