Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 3869 | TN |
NPI | 1215088216 |
---|---|
Provider Name | Mrs. Delana Faye Horton |
First Address | Johnson City, TN 37604-6519 |
Second Address | Johnson City, TN 37604-6519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |