Provider Demographics
NPI:1912121112
Name:OCEAN DENTAL OF OHIO, P.C.
Entity type:Organization
Organization Name:OCEAN DENTAL OF OHIO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-707-0600
Mailing Address - Street 1:206 W. SIXTH 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:405-707-0600
Mailing Address - Fax:405-707-0602
Practice Address - Street 1:3646 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-2913
Practice Address - Country:US
Practice Address - Phone:614-231-4800
Practice Address - Fax:614-231-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2680899Medicaid
OH112063OtherDORAL PROVIDER NUMBER
OH2680899Medicaid