Provider Demographics
NPI:1912008764
Name:HORMAN, KRISTIN M (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:M
Last Name:HORMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 MERCER COURT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:301-695-8969
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS ROAD
Practice Address - Street 2:SUITE 148
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742
Practice Address - Country:US
Practice Address - Phone:240-313-9660
Practice Address - Fax:240-313-9661
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice