Provider Demographics
NPI:1104014091
Name:HORNE, VANCE LAWSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:VANCE
Middle Name:LAWSON
Last Name:HORNE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CENTRE ST
Mailing Address - Street 2:STE #2
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2548
Mailing Address - Country:US
Mailing Address - Phone:207-443-6255
Mailing Address - Fax:
Practice Address - Street 1:130 CENTRE ST
Practice Address - Street 2:STE #2
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2548
Practice Address - Country:US
Practice Address - Phone:207-443-6255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist