Provider Demographics
NPI:1265846489
Name:HORTON, MAGGIE (DMD)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GAINESBOROUGH DR
Mailing Address - Street 2:APARTMENT 1815
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7093
Mailing Address - Country:US
Mailing Address - Phone:843-499-5449
Mailing Address - Fax:
Practice Address - Street 1:421 BARONY ST
Practice Address - Street 2:SUITE 7
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3145
Practice Address - Country:US
Practice Address - Phone:843-761-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist