Provider Demographics
NPI:1972687028
Name:DR. TY E. HORNSBY
Entity Type:Organization
Organization Name:DR. TY E. HORNSBY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HORNSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:828-693-4163
Mailing Address - Street 1:902 FLEMING ST.
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791
Mailing Address - Country:US
Mailing Address - Phone:828-693-4163
Mailing Address - Fax:828-693-4121
Practice Address - Street 1:902 FLEMING ST.
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791
Practice Address - Country:US
Practice Address - Phone:828-693-4163
Practice Address - Fax:828-693-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC94145OtherBCBSOF NC
NC8994145Medicaid
NC8994145Medicaid