Individual
DR. THOMAS CHARLES OCHELTREE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
109 N REGENCY DR, BLOOMINGTON, IL 61701-3515
(309) 663-2526
(309) 663-4788
Mailing address
109 N REGENCY DR, BLOOMINGTON, IL 61701-3515
(309) 663-2526
(309) 663-4788
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
019025084
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019025084
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019025084
DENTAL LICENSE NUMBER
IL
Enumeration date
04/21/2006
Last updated
04/06/2026
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