Provider Demographics
NPI:1972566412
Name:HORNUNG, NEIL S (DMD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:S
Last Name:HORNUNG
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 1:88 MONTVALE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3643
Mailing Address - Country:US
Mailing Address - Phone:781-438-7206
Mailing Address - Fax:781-279-9029
Practice Address - Street 1:88 MONTVALE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3643
Practice Address - Country:US
Practice Address - Phone:781-438-7206
Practice Address - Fax:781-279-9029
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0265179Medicaid
MAT56512Medicare UPIN
MAX04590Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID#