Provider Demographics
NPI:1528631124
Name:HORN, BENJAMIN JACK (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JACK
Last Name:HORN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S SOUTHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4026
Mailing Address - Country:US
Mailing Address - Phone:415-225-0932
Mailing Address - Fax:
Practice Address - Street 1:NMLPDC BLDNG 1 16TH DECK 8955 WOOD RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:415-225-0932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist