MEDICARE: WALTER NEAL HORN D.D.S., MS

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	1223E0200X	Endodontics	22591	TX

General Provider Information

NPI Number	:	1144439589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER NEAL HORN D.D.S., MS

Provider Business Mailing Address
First Line	:	2009 LAZY LN
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76262-9071
Country	:	US
Telephone Number	:	817-431-9849
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 AIRPORT FWY
Second Line	:	SUITE 105
City	:	BEDFORD
State	:	TX
Zip	:	76022-6667
Country	:	US
Telephone Number	:	817-283-5544
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	04/14/2010

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