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General NPI Number Information
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NPI Number | 1992983654
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Entity Type | Organization
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Legal Business Name | PATRICIA HORNBACK DMD
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 2426 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4908
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Country | US
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Telephone | 850-785-8574
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Fax | 850-784-9433
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Provider Business Mailing Address
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Address Line | 2426 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4908
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Country | US
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Telephone | 850-785-8574
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Fax | 850-784-9433
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Authorized Official
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Title or Position | SECRETARY
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Name | MISS PATTY J KINARD
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Credential |
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Telephone | 850-785-8574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DN0009234
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License Number State | FL
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