Provider Demographics
NPI:1932285046
Name:HORN, JOHN DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DENNIS
Last Name:HORN
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 1:2707 N BROADWAY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5544
Mailing Address - Country:US
Mailing Address - Phone:918-649-1099
Mailing Address - Fax:918-649-1099
Practice Address - Street 1:2707 N BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5544
Practice Address - Country:US
Practice Address - Phone:918-649-1099
Practice Address - Fax:918-649-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice