=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912003179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG W HORNER DDS, PC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11757 W KEN CARYL AVE UNIT K
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-3719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-972-9710
-----------------------------------------------------
Fax | 303-972-9704
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11757 W KEN CARYL AVE UNIT K
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-3719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-972-9710
-----------------------------------------------------
Fax | 303-972-9704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 104324
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------