Provider Demographics
NPI:1215141312
Name:GARY HORN D.D.S. P.C.
Entity type:Organization
Organization Name:GARY HORN D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-634-4805
Mailing Address - Street 1:1935 N. UNION BLVD.
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-634-4805
Mailing Address - Fax:719-633-8058
Practice Address - Street 1:1935 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2229
Practice Address - Country:US
Practice Address - Phone:719-634-4805
Practice Address - Fax:719-633-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty