Provider Demographics
NPI:1417939281
Name:HORAN, JASON BRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRIAN
Last Name:HORAN
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 1:250 W MAIN ST
Mailing Address - Street 2:STE. B
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1070
Mailing Address - Country:US
Mailing Address - Phone:740-695-4504
Mailing Address - Fax:740-695-4502
Practice Address - Street 1:250 W MAIN ST
Practice Address - Street 2:STE. B
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1070
Practice Address - Country:US
Practice Address - Phone:740-695-4504
Practice Address - Fax:740-695-4502
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0353741223G0001X
OH30-0224701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01943692Medicare ID - Type Unspecified