Provider Demographics
NPI:1306955240
Name:HORTMAN, ROBERT P (DMD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:HORTMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:ANDREW
Other - Middle Name:KYLE
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:15 PROFESSIONAL CT SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2844
Mailing Address - Country:US
Mailing Address - Phone:706-291-0555
Mailing Address - Fax:706-291-3734
Practice Address - Street 1:15 PROFESSIONAL CT SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2844
Practice Address - Country:US
Practice Address - Phone:706-291-0555
Practice Address - Fax:706-291-3734
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice