Provider Demographics
NPI:1043424401
Name:HORTON, DARYL G (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:G
Last Name:HORTON
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 1:1740-A SOUTH GLENSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1514
Mailing Address - Country:US
Mailing Address - Phone:417-887-8868
Mailing Address - Fax:
Practice Address - Street 1:1740-A SOUTH GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1514
Practice Address - Country:US
Practice Address - Phone:417-887-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0126581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice