Provider Demographics
NPI:1841289048
Name:HORTON, ROBERT LESLIE JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LESLIE
Last Name:HORTON
Suffix:JR
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:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1027
Mailing Address - Country:US
Mailing Address - Phone:731-584-4560
Mailing Address - Fax:731-584-8267
Practice Address - Street 1:180 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1618
Practice Address - Country:US
Practice Address - Phone:731-584-4560
Practice Address - Fax:731-584-8267
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS23171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3216712Medicaid