Healthcare Provider Details

I. General information

NPI: 1497962682
Provider Name (Legal Business Name): JASON CHARLES HORWITZ D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 DAVENPORT DR
TRINITY FL
34655-4231
US

IV. Provider business mailing address

1641 DAVENPORT DR
TRINITY FL
34655-4231
US

V. Phone/Fax

Practice location:
  • Phone: 727-789-1980
  • Fax: 727-789-4686
Mailing address:
  • Phone: 727-789-1980
  • Fax: 727-789-4686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN15177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: