Provider Demographics
NPI:1871560706
Name:HORNE, LAWERENCE S (DMD)
Entity type:Individual
Prefix:DR
First Name:LAWERENCE
Middle Name:S
Last Name:HORNE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HOLLYWOOD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4922
Mailing Address - Country:US
Mailing Address - Phone:850-269-7550
Mailing Address - Fax:
Practice Address - Street 1:105 HOLLYWOOD BLVD NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4922
Practice Address - Country:US
Practice Address - Phone:850-269-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167461223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice