MEDICARE: GARY HORN D.D.S. P.C.

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	122300000X	Dentist	00497	CO

General Provider Information

NPI Number	:	1215141312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY HORN D.D.S. P.C.

Provider Business Mailing Address
First Line	:	1935 N. UNION BLVD.
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909
Country	:	US
Telephone Number	:	719-634-4805
Fax Number	:	719-633-8058

Provider Business Practice Location Address
First Line	:	1935 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2229
Country	:	US
Telephone Number	:	719-634-4805
Fax Number	:	719-633-8058

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY K. HORN
Credential	:
Telephone Number	:	719-634-4805

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/19/2012

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