Provider Demographics
NPI:1215170055
Name:VAN HORN, TONI G (RDH, BS)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:G
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14905 KAREN ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5323
Mailing Address - Country:US
Mailing Address - Phone:402-896-2963
Mailing Address - Fax:
Practice Address - Street 1:1411 J F KENNEDY DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3639
Practice Address - Country:US
Practice Address - Phone:402-291-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1141124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist