Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | TBD | NC |
NPI | 1104387117 |
---|---|
Provider Name | Tyler Don Horton |
First Address | Fort Worth, TX 76104-4917 |
Second Address | Chapel Hill, NC 27599-4917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2019 |
Last Update Date | 21/06/2020 |