Provider Demographics
NPI:1063655009
Name:HORNBEAK, DAQUANT N ((DDS))
Entity Type:Individual
Prefix:
First Name:DAQUANT
Middle Name:N
Last Name:HORNBEAK
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 1:4000 MITCHELLVILLE RD STE B426
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3159
Mailing Address - Country:US
Mailing Address - Phone:240-334-2930
Mailing Address - Fax:240-334-2931
Practice Address - Street 1:4000 MITCHELLVILLE RD STE B426
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3159
Practice Address - Country:US
Practice Address - Phone:240-334-2930
Practice Address - Fax:240-334-2931
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD144351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD46-4087563OtherMARYLAND STATE TAX ID