Provider Demographics
NPI:1346326816
Name:HORNER, JAMES LESTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LESTER
Last Name:HORNER
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 1:168 14TH ST SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-6103
Mailing Address - Country:US
Mailing Address - Phone:727-585-5494
Mailing Address - Fax:727-581-6437
Practice Address - Street 1:168 14TH ST SW
Practice Address - Street 2:SUITE B
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-6103
Practice Address - Country:US
Practice Address - Phone:727-585-5494
Practice Address - Fax:727-581-6437
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN118221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592332536Medicare UPIN
FL63283YMedicare ID - Type UnspecifiedTYRONE
FL97405AMedicare ID - Type UnspecifiedTYRONE GROUP
FL97405Medicare ID - Type UnspecifiedL & NE GROUP
FL63283ZMedicare ID - Type UnspecifiedLARGO
FL190003347Medicare ID - Type UnspecifiedRAIL ROAD
FL63283ZMedicare ID - Type UnspecifiedNE