Provider Demographics
NPI:1023446671
Name:HOCKEMA, KRISTIN NICOLE (BS, RDH, EPDH)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICOLE
Last Name:HOCKEMA
Suffix:
Gender:F
Credentials:BS, RDH, EPDH
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:NICOLE
Other - Last Name:KINTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, RDH, EPDH
Mailing Address - Street 1:3000 MARKET ST NE STE 228
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-585-5205
Mailing Address - Fax:
Practice Address - Street 1:3000 MARKET ST NE STE 228
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1803
Practice Address - Country:US
Practice Address - Phone:503-585-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6611124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist