MEDICARE: DR. DAVID MICHAEL HORN 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	1223G0001X	General Practice Dentistry	23138	NJ
2	1223E0200X	Endodontics	23329	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366578262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MICHAEL HORN DDS

Provider Business Mailing Address
First Line	:	2776 RINGOLD RD
Second Line	:	ATTN: USA DENTAC, RENEE CHASE
City	:	FORT SILL
State	:	OK
Zip	:	73503-4449
Country	:	US
Telephone Number	:	580-442-3905
Fax Number	:

Provider Business Practice Location Address
First Line	:	2776 RINGOLD RD
Second Line	:	ATTN: USA DENTAC, RENEE CHASE
City	:	FORT SILL
State	:	OK
Zip	:	73503-4449
Country	:	US
Telephone Number	:	580-442-3905
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	10/05/2010

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