Provider Demographics
NPI:1366578262
Name:HORN, DAVID MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:HORN
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 1:2776 RINGOLD RD
Mailing Address - Street 2:ATTN: USA DENTAC, RENEE CHASE
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-4449
Mailing Address - Country:US
Mailing Address - Phone:580-442-3905
Mailing Address - Fax:
Practice Address - Street 1:2776 RINGOLD RD
Practice Address - Street 2:ATTN: USA DENTAC, RENEE CHASE
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4449
Practice Address - Country:US
Practice Address - Phone:580-442-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ231381223G0001X
TX233291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0109339Medicaid