Provider Demographics
NPI:1649251570
Name:HOROWTIZ, JEFFREY ALLAN (DDS MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:HOROWTIZ
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 W END AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-1825
Mailing Address - Country:US
Mailing Address - Phone:570-622-9746
Mailing Address - Fax:570-622-3723
Practice Address - Street 1:2257 W END AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1825
Practice Address - Country:US
Practice Address - Phone:570-622-9746
Practice Address - Fax:570-622-3723
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031220L122300000X
PADS031220-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018170890001Medicaid
PA484716OtherHIGHMARK BLUE SHIELD
PA2438481OtherAETNA
PA50004506OtherCAPITAL BLUE CROSS
PA50004506OtherCAPITAL BLUE CROSS
U81572Medicare UPIN