Provider Demographics
NPI:1710988993
Name:HORNE, ROBERT PARKS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PARKS
Last Name:HORNE
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 1:4747 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1804
Mailing Address - Country:US
Mailing Address - Phone:203-371-5595
Mailing Address - Fax:203-372-4912
Practice Address - Street 1:4747 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1804
Practice Address - Country:US
Practice Address - Phone:203-371-5595
Practice Address - Fax:203-372-4912
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00012981223S0112X
PADS0361821223S0112X
CT110511223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery