Provider Demographics
NPI:1104402544
Name:HORN FAMILY DENTAL, PLLC
Entity type:Organization
Organization Name:HORN FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-656-5591
Mailing Address - Street 1:247 BYRD AVE N
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-3043
Mailing Address - Country:US
Mailing Address - Phone:601-656-5591
Mailing Address - Fax:
Practice Address - Street 1:247 BYRD AVE N
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3043
Practice Address - Country:US
Practice Address - Phone:601-656-5591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental