Provider Demographics
NPI:1093849325
Name:HOROWITZ, MARC LANCE (DDS)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:LANCE
Last Name:HOROWITZ
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:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-0605
Mailing Address - Country:US
Mailing Address - Phone:207-667-2770
Mailing Address - Fax:207-667-2744
Practice Address - Street 1:81 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643-3000
Practice Address - Country:US
Practice Address - Phone:207-483-4502
Practice Address - Fax:207-483-4778
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME289000099Medicaid