Provider Demographics
NPI:1215068077
Name:HORNE, MATTHEW WATSON (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WATSON
Last Name:HORNE
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 1:3345 BEE CAVES RD STE 102B
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5463
Mailing Address - Country:US
Mailing Address - Phone:512-329-5250
Mailing Address - Fax:512-329-5068
Practice Address - Street 1:3345 BEE CAVES RD STE 102B
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5463
Practice Address - Country:US
Practice Address - Phone:512-329-5250
Practice Address - Fax:512-329-5068
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice