Provider Demographics
NPI:1811011893
Name:HORNICK, JOHN FREDERIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERIC
Last Name:HORNICK
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 1:2812 MOUNTAIN LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1542
Mailing Address - Country:US
Mailing Address - Phone:215-230-7175
Mailing Address - Fax:
Practice Address - Street 1:1151 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5340
Practice Address - Country:US
Practice Address - Phone:215-616-0855
Practice Address - Fax:215-616-0955
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0356561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice