Provider Demographics
NPI:1477761583
Name:HORODOWICZ, JERRY JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:JOHN
Last Name:HORODOWICZ
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 1:6700 RIDGE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3960
Mailing Address - Country:US
Mailing Address - Phone:410-574-8600
Mailing Address - Fax:
Practice Address - Street 1:6700 RIDGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3960
Practice Address - Country:US
Practice Address - Phone:410-574-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD93011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice