Provider Demographics
NPI:1679274005
Name:HORNING, PHILIP DIMITRI
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:DIMITRI
Last Name:HORNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 NE ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7751
Mailing Address - Country:US
Mailing Address - Phone:541-640-9524
Mailing Address - Fax:
Practice Address - Street 1:812 NW YORK DR STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-6746
Practice Address - Country:US
Practice Address - Phone:541-200-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD119661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty