MEDICARE: OCEAN DENTAL, PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1952441289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN DENTAL, PC

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	:	405-707-0602

Provider Business Practice Location Address
First Line	:	3919 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-2005
Country	:	US
Telephone Number	:	405-787-7827
Fax Number	:	405-470-1838

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	12/03/2007

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