MEDICARE: HORNER BARROW ORTHODONTICS, PC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	M647	SD

General Provider Information

NPI Number	:	1528482916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORNER BARROW ORTHODONTICS, PC

Provider Business Mailing Address
First Line	:	2407 W 57TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5026
Country	:	US
Telephone Number	:	605-335-6680
Fax Number	:	605-335-8342

Provider Business Practice Location Address
First Line	:	2407 W 57TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5026
Country	:	US
Telephone Number	:	605-335-6680
Fax Number	:	605-335-8342

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. KEVIN DONALD HORNER
Credential	:	DDS, MS
Telephone Number	:	605-335-6680

Provider Enumeration Date	:	02/06/2014
Last Update Date	:	02/06/2014

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