Provider Demographics
NPI:1336348127
Name:HORIZON SMILES, PLLC
Entity Type:Organization
Organization Name:HORIZON SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIS
Authorized Official - Middle Name:ELBERT
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-852-5111
Mailing Address - Street 1:14509 HORIZON BLVD
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928
Mailing Address - Country:US
Mailing Address - Phone:915-852-5111
Mailing Address - Fax:915-852-1067
Practice Address - Street 1:14509 HORIZON BLVD
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-8564
Practice Address - Country:US
Practice Address - Phone:915-852-5111
Practice Address - Fax:915-852-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223X0400X
TX11040302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty