Provider Demographics
NPI:1033178256
Name:VAN HORN, KEITH D (DDS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:VAN HORN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 YALE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2647
Mailing Address - Country:US
Mailing Address - Phone:785-842-0705
Mailing Address - Fax:785-865-2324
Practice Address - Street 1:2210 YALE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2647
Practice Address - Country:US
Practice Address - Phone:785-842-0705
Practice Address - Fax:785-865-2324
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS603411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000116889OtherBCBS