Provider Demographics
NPI:1013014984
Name:HOECKER, CHAD BRANDON (DDS)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:BRANDON
Last Name:HOECKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4017
Mailing Address - Country:US
Mailing Address - Phone:405-707-6199
Mailing Address - Fax:405-707-0602
Practice Address - Street 1:510 S DUCK ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4051
Practice Address - Country:US
Practice Address - Phone:405-377-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53591223G0001X
TX119201223G0001X
OH30-0221031223G0001X
IN12010776A1223G0001X
AR35491223G0001X
NE65961223G0001X
WADE000104831223G0001X
VA04014113211223G0001X
AZ68981223G0001X
CO93081223G0001X
IL019.0272571223G0001X
AK12221223G0001X
TNDS00000086141223G0001X
PADS0370811223G0001X
IA084531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH26241491Medicaid
OH17579OtherDORAL DENTAL OF OHIO
OK100091480BMedicaid