Provider Demographics
NPI:1578666137
Name:HOCHSTADTER, BRUCE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:HOCHSTADTER
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 1:444 N NORTHWEST NWY
Mailing Address - Street 2:SUITE 325
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-296-6100
Mailing Address - Fax:847-296-8706
Practice Address - Street 1:444 N NORTHWEST NWY
Practice Address - Street 2:SUITE 325
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-296-6100
Practice Address - Fax:847-296-8706
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021000812 190136121223S0112X
IL1370001001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0080004915OtherBCBS OF IL GROUP #
0080004915OtherBCBS OF IL GROUP #
K17839Medicare ID - Type UnspecifiedWPS
T37152Medicare UPIN