MEDICARE: DR. DORSEY L VANHORN DMD

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	DN009392	GA

General Provider Information

NPI Number	:	1689740730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DORSEY L VANHORN DMD

Provider Business Mailing Address
First Line	:	530 RED BUD ROAD
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-1961
Country	:	US
Telephone Number	:	706-625-4190
Fax Number	:	706-625-4199

Provider Business Practice Location Address
First Line	:	530 RED BUD ROAD
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-1961
Country	:	US
Telephone Number	:	706-625-4190
Fax Number	:	706-625-4199

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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