Provider Demographics
NPI:1689740730
Name:VANHORN, DORSEY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:DORSEY
Middle Name:L
Last Name:VANHORN
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 1:530 RED BUD ROAD
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1961
Mailing Address - Country:US
Mailing Address - Phone:706-625-4190
Mailing Address - Fax:706-625-4199
Practice Address - Street 1:530 RED BUD ROAD
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1961
Practice Address - Country:US
Practice Address - Phone:706-625-4190
Practice Address - Fax:706-625-4199
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist