Provider Demographics
NPI:1336323542
Name:HORN, GAROLD H (RDH)
Entity Type:Individual
Prefix:
First Name:GAROLD
Middle Name:H
Last Name:HORN
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6856
Mailing Address - Country:US
Mailing Address - Phone:208-734-3312
Mailing Address - Fax:208-734-3313
Practice Address - Street 1:401 W CAMAS AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ID
Practice Address - Zip Code:83327
Practice Address - Country:US
Practice Address - Phone:208-764-2611
Practice Address - Fax:208-764-2646
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDH-1810124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist