Provider Demographics
NPI:1679635494
Name:HORNSTEIN, SPENCER GARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:GARY
Last Name:HORNSTEIN
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 1:10401 OLD GEORGETOWN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1911
Mailing Address - Country:US
Mailing Address - Phone:301-530-2700
Mailing Address - Fax:301-530-2953
Practice Address - Street 1:10401 OLD GEORGETOWN RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1911
Practice Address - Country:US
Practice Address - Phone:301-530-2700
Practice Address - Fax:301-530-2953
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD090141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice