Provider Demographics
NPI:1912929753
Name:HORNADAY, JAMES ELLSWORTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ELLSWORTH
Last Name:HORNADAY
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 1:1004 OAK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1916
Mailing Address - Country:US
Mailing Address - Phone:765-935-1997
Mailing Address - Fax:765-939-2861
Practice Address - Street 1:1004 OAK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1916
Practice Address - Country:US
Practice Address - Phone:765-935-1997
Practice Address - Fax:765-939-2861
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007244A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN542780Medicare ID - Type Unspecified
INU27218Medicare UPIN