Provider Demographics
NPI:1104833623
Name:HORSEMAN, JEFFREY ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:HORSEMAN
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 1:9209 COLIMA RD
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1800
Mailing Address - Country:US
Mailing Address - Phone:562-693-7753
Mailing Address - Fax:562-945-0929
Practice Address - Street 1:9209 COLIMA RD
Practice Address - Street 2:SUITE 3500
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1800
Practice Address - Country:US
Practice Address - Phone:562-693-7753
Practice Address - Fax:562-945-0929
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28721122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28721OtherCA STATE DENTAL LICENSE