Provider Demographics
NPI:1407150139
Name:RYAN LAWRENCE HORN, D.D.S.
Entity Type:Organization
Organization Name:RYAN LAWRENCE HORN, D.D.S.
Other - Org Name:BERKELEY PERIODONTICS AND DENTAL IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-843-6341
Mailing Address - Street 1:2999 REGENT ST
Mailing Address - Street 2:SUITE #403
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2190
Mailing Address - Country:US
Mailing Address - Phone:510-843-6341
Mailing Address - Fax:510-845-5128
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:SUITE #403
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2190
Practice Address - Country:US
Practice Address - Phone:510-843-6341
Practice Address - Fax:510-845-5128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RYAN HORN, D.D.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568501223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty