Healthcare Provider Details

I. General information

NPI: 1124081997
Provider Name (Legal Business Name): RICHARD HORWAT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 BROOKWOOD TER
NASHVILLE TN
37205-1405
US

IV. Provider business mailing address

47 BROOKWOOD TER
NASHVILLE TN
37205-1405
US

V. Phone/Fax

Practice location:
  • Phone: 615-353-5678
  • Fax:
Mailing address:
  • Phone: 615-353-5678
  • Fax: 615-353-2098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9429
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: