Provider Demographics
NPI:1073673307
Name:HOORN, DENNIS JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JAY
Last Name:HOORN
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 1:105 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3264
Mailing Address - Country:US
Mailing Address - Phone:269-964-3957
Mailing Address - Fax:269-962-2402
Practice Address - Street 1:105 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3264
Practice Address - Country:US
Practice Address - Phone:269-964-3957
Practice Address - Fax:269-962-2402
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice