Provider Demographics
NPI:1831819770
Name:HORTON, SAMUEL WALTER (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WALTER
Last Name:HORTON
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 1:2015 SACRAMENTO ST APT 304
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3324
Mailing Address - Country:US
Mailing Address - Phone:858-926-8964
Mailing Address - Fax:
Practice Address - Street 1:401 KENILWORTH DR STE 960
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3406
Practice Address - Country:US
Practice Address - Phone:707-789-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist