MEDICARE: RONALD DEE HORNE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	D12740	TX

General Provider Information

NPI Number	:	1013061902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD DEE HORNE DDS

Provider Business Mailing Address
First Line	:	1303 SILVER HILL DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78746-7424
Country	:	US
Telephone Number	:	512-306-0773
Fax Number	:

Provider Business Practice Location Address
First Line	:	4306 MEDICAL PKWY
Second Line	:	SUITE 2
City	:	AUSTIN
State	:	TX
Zip	:	78756-3312
Country	:	US
Telephone Number	:	512-454-6744
Fax Number	:	512-419-0133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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