1245370980 NPI number — OCEAN DENTAL OF ARKANSAS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245370980 NPI number — OCEAN DENTAL OF ARKANSAS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN DENTAL OF ARKANSAS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245370980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 W 6TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STILLWATER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74074-4017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-707-0600
Provider Business Mailing Address Fax Number:
405-707-0602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3024 S UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72204-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-565-0606
Provider Business Practice Location Address Fax Number:
501-565-0601
Provider Enumeration Date:
02/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOECKER
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
405-707-0600

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)