Healthcare Provider Details

I. General information

NPI: 1336348127
Provider Name (Legal Business Name): HORIZON SMILES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14509 HORIZON BLVD
HORIZON CITY TX
79928-8564
US

IV. Provider business mailing address

14509 HORIZON BLVD
HORIZON CITY TX
79928
US

V. Phone/Fax

Practice location:
  • Phone: 915-852-5111
  • Fax: 915-852-1067
Mailing address:
  • Phone: 915-852-5111
  • Fax: 915-852-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number11040
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIS ELBERT MAXWELL
Title or Position: OWNER/ORTHODONTIST
Credential: DDS
Phone: 915-852-5111