Provider Demographics
NPI:1699707026
Name:HORTON, MARK MARION (DMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:MARION
Last Name:HORTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620
Mailing Address - Country:US
Mailing Address - Phone:864-366-9653
Mailing Address - Fax:
Practice Address - Street 1:92 HIGHWAY 72 WEST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620
Practice Address - Country:US
Practice Address - Phone:864-366-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC2536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZ2536Medicare ID - Type Unspecified