Provider Demographics
NPI:1407897523
Name:HORNADAY, ANTHONY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:HORNADAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4448
Mailing Address - Country:US
Mailing Address - Phone:765-289-9705
Mailing Address - Fax:765-289-9706
Practice Address - Street 1:620 S TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4448
Practice Address - Country:US
Practice Address - Phone:765-289-9705
Practice Address - Fax:765-289-9706
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010160A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200421550Medicaid
IN200421550Medicaid
IN201310Medicare ID - Type Unspecified