Individual
JOHN JACOB HORRES IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
101 RUTLEDGE AVE, CHARLESTON, SC 29401-1722
(843) 722-3199
Mailing address
101 RUTLEDGE AVE, CHARLESTON, SC 29401-1722
(843) 722-3199
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2073
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279623
—
SC
Enumeration date
12/18/2006
Last updated
07/08/2007
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