MEDICARE: DR. JASON BRIAN HORAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS035374	PA
2	1223G0001X	General Practice Dentistry	30-022470	OH

General Provider Information

NPI Number	:	1417939281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON BRIAN HORAN DMD

Provider Business Mailing Address
First Line	:	250 W MAIN ST
Second Line	:	STE. B
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-1070
Country	:	US
Telephone Number	:	740-695-4504
Fax Number	:	740-695-4502

Provider Business Practice Location Address
First Line	:	250 W MAIN ST
Second Line	:	STE. B
City	:	SAINT CLAIRSVILLE
State	:	OH
Zip	:	43950-1070
Country	:	US
Telephone Number	:	740-695-4504
Fax Number	:	740-695-4502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	11/06/2014

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