Provider Demographics
NPI:1588226906
Name:SOUTHERN TIER ORTHODONTICS PC
Entity Type:Organization
Organization Name:SOUTHERN TIER ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-880-1613
Mailing Address - Street 1:51 W 86TH ST APT 301
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3617
Mailing Address - Country:US
Mailing Address - Phone:917-880-1613
Mailing Address - Fax:
Practice Address - Street 1:440 E WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3411
Practice Address - Country:US
Practice Address - Phone:607-733-7163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty