Healthcare Provider Details

I. General information

NPI: 1780818245
Provider Name (Legal Business Name): JESSICA JOAN HOROWITZ RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 COMMERCE PARK
ELLSWORTH ME
04605
US

IV. Provider business mailing address

PO BOX 605
ELLSWORTH ME
04605
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-2770
  • Fax: 207-667-2744
Mailing address:
  • Phone: 207-667-2770
  • Fax: 207-667-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3099
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: