Provider Demographics
NPI:1992921068
Name:HORN, GARY KENNETH (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:KENNETH
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 1:320 E FONTANERO ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7529
Mailing Address - Country:US
Mailing Address - Phone:719-634-4805
Mailing Address - Fax:719-634-3610
Practice Address - Street 1:320 E FONTANERO ST
Practice Address - Street 2:SUITE 302
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7529
Practice Address - Country:US
Practice Address - Phone:719-634-4805
Practice Address - Fax:719-634-3610
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO004971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice