Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D8530 | OR |
Y | 1223P0300X | Periodontist | 56850 | CA |
NPI | 1104880111 |
---|---|
Provider Name | Ryan Lawrence Horn |
First Address | El Cerrito, CA 94530-2961 |
Second Address | El Cerrito, CA 94530-2961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 18/07/2008 |