Provider Demographics
NPI:1558550509
Name:PHILIP K. HORNSETH, D.D.S., S.C.
Entity type:Organization
Organization Name:PHILIP K. HORNSETH, D.D.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:HORNSETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-731-1550
Mailing Address - Street 1:2101 E CALUMET ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4743
Mailing Address - Country:US
Mailing Address - Phone:920-731-1550
Mailing Address - Fax:920-731-4403
Practice Address - Street 1:2101 E CALUMET ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4743
Practice Address - Country:US
Practice Address - Phone:920-731-1550
Practice Address - Fax:920-731-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1431G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty