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Individual

KATHRYN L HORUTZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
173 OCEAN AVE, PORTLAND, ME 04103-5728
(207) 772-1205
(207) 773-7414
Mailing address
173 OCEAN AVE, PORTLAND, ME 04103-5728
(207) 772-1205
(207) 773-7414

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
3241
NH
1223G0001X
General Practice Dentistry
Primary
4012
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02Y003864NH01
ANTHEM BLUE CROSS BLUE SH
05
30302635
NH
Enumeration date
08/04/2006
Last updated
07/08/2007
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