Provider Demographics
NPI:1417027152
Name:HORECKY, ERIC CONRAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CONRAD
Last Name:HORECKY
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 1:886 TUPELO BAY DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8241
Mailing Address - Country:US
Mailing Address - Phone:843-881-9525
Mailing Address - Fax:
Practice Address - Street 1:152 CIVITAS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6692
Practice Address - Country:US
Practice Address - Phone:843-388-0059
Practice Address - Fax:843-388-0019
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice