Provider Demographics
NPI:1770134876
Name:RED RIVER ORAL SURGERY
Entity type:Organization
Organization Name:RED RIVER ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HORNBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-899-5218
Mailing Address - Street 1:4616 US HWY 75 # 201
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4582
Mailing Address - Country:US
Mailing Address - Phone:903-416-8585
Mailing Address - Fax:903-416-8484
Practice Address - Street 1:4616 HIGHWAY 75
Practice Address - Street 2:SUITE 201
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020
Practice Address - Country:US
Practice Address - Phone:713-899-5218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty