Provider Demographics
NPI:1245453893
Name:HORSTMEYER, GREGG W (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:W
Last Name:HORSTMEYER
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 1:2038 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-1603
Mailing Address - Country:US
Mailing Address - Phone:765-644-4343
Mailing Address - Fax:765-644-4709
Practice Address - Street 1:2038 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-1603
Practice Address - Country:US
Practice Address - Phone:765-644-4343
Practice Address - Fax:765-644-4709
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008398A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist