Provider Demographics
NPI:1215088216
Name:HORTON, DELANA FAYE (RDH)
Entity type:Individual
Prefix:MRS
First Name:DELANA
Middle Name:FAYE
Last Name:HORTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SW AVE EXT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6519
Mailing Address - Country:US
Mailing Address - Phone:423-979-3200
Mailing Address - Fax:423-979-3267
Practice Address - Street 1:1233 SW AVE EXT
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6519
Practice Address - Country:US
Practice Address - Phone:423-979-3200
Practice Address - Fax:423-979-3267
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38691223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health