Basic Information
| Provider Information | |||||||||
| NPI: | 1013014984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOECKER | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | BRANDON | ||||||||
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| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 206 W 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740744017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057076199 | ||||||||
| FaxNumber: | 4057070602 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 S DUCK ST | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740744051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053777300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 11/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 5359 | OK | Y | Dental Providers | Dentist | General Practice | 1223G0001X | 11920 | TX | N | Dental Providers | Dentist | General Practice | 1223G0001X | 30-022103 | OH | N | Dental Providers | Dentist | General Practice | 1223G0001X | 12010776A | IN | N | Dental Providers | Dentist | General Practice | 1223G0001X | 3549 | AR | N | Dental Providers | Dentist | General Practice | 1223G0001X | 6596 | NE | N | Dental Providers | Dentist | General Practice | 1223G0001X | DE00010483 | WA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 0401411321 | VA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 6898 | AZ | N | Dental Providers | Dentist | General Practice | 1223G0001X | 9308 | CO | N | Dental Providers | Dentist | General Practice | 1223G0001X | 019.027257 | IL | N | Dental Providers | Dentist | General Practice | 1223G0001X | 1222 | AK | N | Dental Providers | Dentist | General Practice | 1223G0001X | DS0000008614 | TN | N | Dental Providers | Dentist | General Practice | 1223G0001X | DS037081 | PA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 08453 | IA | N | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 26241491 | 05 | OH | MEDICAID | 17579 | 01 | OH | DORAL DENTAL OF OHIO | OTHER | 100091480B | 05 | OK | MEDICAID |