Provider Demographics
NPI:1396806972
Name:HORN, JUANA CLELIA (DDS)
Entity type:Individual
Prefix:
First Name:JUANA
Middle Name:CLELIA
Last Name:HORN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 VALLIMONT DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1028
Mailing Address - Country:US
Mailing Address - Phone:215-917-6575
Mailing Address - Fax:
Practice Address - Street 1:2414 LYTLE RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2736
Practice Address - Country:US
Practice Address - Phone:412-835-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031327L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001841342Medicaid
PA001841342Medicare ID - Type Unspecified