Provider Demographics
NPI:1093370967
Name:HORNAK, DAVID ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:HORNAK
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 1:207 STORNOWAY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7517
Mailing Address - Country:US
Mailing Address - Phone:980-422-6146
Mailing Address - Fax:
Practice Address - Street 1:1408 SKIBO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3411
Practice Address - Country:US
Practice Address - Phone:910-354-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032296122300000X
NC12261171000000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No171000000XOther Service ProvidersMilitary Health Care Provider