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General NPI Number Information
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NPI Number | 1265388862
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF MARSHALL LLP
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 1900 S WASHINGTON AVE STE A
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City | MARSHALL
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State | TX
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Zip | 75670-6845
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Country | US
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Telephone | 903-503-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 3116 H G MOSLEY PKWY
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City | LONGVIEW
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State | TX
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Zip | 75605-2941
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Country | US
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Telephone | 903-544-6060
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JUSTIN HORNE
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Credential | DDS
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Telephone | 903-544-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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