Provider Demographics
NPI:1720204373
Name:HORTON, CRAIG ALEXANDER (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALEXANDER
Last Name:HORTON
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 1:519 IVY SPRING CT
Mailing Address - Street 2:APT 127
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-5750
Mailing Address - Country:US
Mailing Address - Phone:864-710-2410
Mailing Address - Fax:864-710-2410
Practice Address - Street 1:519 IVY SPRING CT
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-5750
Practice Address - Country:US
Practice Address - Phone:864-710-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4105OtherSTATE LICENSE NUMBER