MEDICARE: DR. BRUCE BRIAN HORSWELL MD, DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	12013297A	IN

General Provider Information

NPI Number	:	1417911975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE BRIAN HORSWELL MD, DDS

Provider Business Mailing Address
First Line	:	830 PENNSYLVANIA AVE 302
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-3390
Country	:	US
Telephone Number	:	304-388-2950
Fax Number	:	304-388-2951

Provider Business Practice Location Address
First Line	:	550 UNIVERSITY BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5149
Country	:	US
Telephone Number	:	317-274-8300
Fax Number	:	317-274-0965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	06/17/2026

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