Provider Demographics
NPI:1053449330
Name:HORN, STUART JEROME (DMD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:JEROME
Last Name:HORN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 GREENTREE DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2628
Mailing Address - Country:US
Mailing Address - Phone:860-633-8646
Mailing Address - Fax:
Practice Address - Street 1:599 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5156
Practice Address - Country:US
Practice Address - Phone:860-647-1565
Practice Address - Fax:860-643-2796
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT50961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT020005096CT01OtherANTHEM FEDERAL
CT120905OtherUNITED CONCORDIA
CTZ05940OtherBCBS MASS