Healthcare Provider Details

I. General information

NPI: 1124132139
Provider Name (Legal Business Name): KILLIAN JOSEPH HORNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 TAYLOR ROAD
MONTGOMERY AL
36117-3498
US

IV. Provider business mailing address

2201 TAYLOR ROAD
MONTGOMERY AL
36117-3498
US

V. Phone/Fax

Practice location:
  • Phone: 334-271-4600
  • Fax: 334-271-4709
Mailing address:
  • Phone: 334-271-4600
  • Fax: 334-271-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4000
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: