Provider Demographics
NPI:1952542151
Name:HORTON, DEIDRE RENAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEIDRE
Middle Name:RENAE
Last Name:HORTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 DOVE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5068
Mailing Address - Country:US
Mailing Address - Phone:704-282-9961
Mailing Address - Fax:704-282-9965
Practice Address - Street 1:1307 DOVE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5068
Practice Address - Country:US
Practice Address - Phone:704-282-9961
Practice Address - Fax:704-282-9965
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist