Provider Demographics
NPI:1265584189
Name:COMBS, HORACE EUGENE III (DMD)
Entity type:Individual
Prefix:DR
First Name:HORACE
Middle Name:EUGENE
Last Name:COMBS
Suffix:III
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 1:500 GOODYEAR BLVD
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3217
Mailing Address - Country:US
Mailing Address - Phone:601-798-0500
Mailing Address - Fax:
Practice Address - Street 1:500 GOODYEAR BLVD
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3217
Practice Address - Country:US
Practice Address - Phone:601-798-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3213-021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice