Provider Demographics
NPI:1669082905
Name:HORNBERGER, JACOB (DDS)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:HORNBERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:HORNBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6500 E MOCKINGBIRD LN STE 115
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2483
Mailing Address - Country:US
Mailing Address - Phone:214-324-0233
Mailing Address - Fax:
Practice Address - Street 1:6500 E MOCKINGBIRD LN STE 115
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2483
Practice Address - Country:US
Practice Address - Phone:214-324-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice