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General NPI Number Information
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NPI Number | 1558550509
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Entity Type | Organization
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Legal Business Name | PHILIP K. HORNSETH, D.D.S., S.C.
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 2101 E CALUMET ST
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City | APPLETON
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State | WI
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Zip | 54915-4743
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Country | US
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Telephone | 920-731-1550
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Fax | 920-731-4403
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Provider Business Mailing Address
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Address Line | 2101 E CALUMET ST
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City | APPLETON
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State | WI
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Zip | 54915-4743
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Country | US
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Telephone | 920-731-1550
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Fax | 920-731-4403
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. PHILIP K HORNSETH
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Credential | D.D.S.
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Telephone | 920-731-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1431G
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License Number State | WI
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