Healthcare Provider Details

I. General information

NPI: 1912929753
Provider Name (Legal Business Name): JAMES ELLSWORTH HORNADAY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 OAK DR
RICHMOND IN
47374-1916
US

IV. Provider business mailing address

1004 OAK DR
RICHMOND IN
47374-1916
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-1997
  • Fax: 765-939-2861
Mailing address:
  • Phone: 765-935-1997
  • Fax: 765-939-2861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12007244A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: