Basic Information
| Provider Information | |||||||||
| NPI: | 1578737854 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OCEAN DENTAL OF INDIANA, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 W 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740744017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057070600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4150 LAFAYETTE RD | ||||||||
| Address2: | SUITE J | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462545443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172801447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2008 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | HOECKER | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
| AuthorizedOfficialMiddleName: | BRANDON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4057070600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.