Provider Demographics
NPI:1124132139
Name:HORNER, KILLIAN JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:KILLIAN
Middle Name:JOSEPH
Last Name:HORNER
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 1:2201 TAYLOR ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3498
Mailing Address - Country:US
Mailing Address - Phone:334-271-4600
Mailing Address - Fax:334-271-4709
Practice Address - Street 1:2201 TAYLOR ROAD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3498
Practice Address - Country:US
Practice Address - Phone:334-271-4600
Practice Address - Fax:334-271-4709
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL90188OtherBCBS
816933OtherUNITED CONCORDIA