Provider Demographics
NPI:1528178225
Name:HORN, RANDY (DDS)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
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 1:530 LOMAS SANTA FE DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075
Mailing Address - Country:US
Mailing Address - Phone:858-794-9994
Mailing Address - Fax:858-794-9993
Practice Address - Street 1:530 LOMAS SANTA FE DR
Practice Address - Street 2:SUITE #2
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075
Practice Address - Country:US
Practice Address - Phone:858-794-9994
Practice Address - Fax:858-794-9993
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice