Provider Demographics
NPI:1811314131
Name:HORST, NADJA A (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:NADJA
Middle Name:A
Last Name:HORST
Suffix:
Gender:F
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1924
Mailing Address - Country:US
Mailing Address - Phone:954-525-5662
Mailing Address - Fax:954-525-5251
Practice Address - Street 1:104 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1924
Practice Address - Country:US
Practice Address - Phone:954-525-5662
Practice Address - Fax:954-525-5251
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist