Travis Wayne Horn, DDS
Individual provider Active NPI Dentist · Jefferson, TX
NPI 1518697366 · NPPES record last updated May 25, 2023
Key facts
- NPI
- 1518697366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 38609 (TX)
- Practice address
- 601 N Walnut St
Jefferson, TX 75657-1851 - Phone
- (903) 665-3914
- NPI assigned
- Jun 14, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38609 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Etx Dental PLLC | Current |
Accepting new patients | |
| Shahid Dental Group Gladewater, PLLC | Dentist | Past |
Accepting new patients |
| Kent Thigpen, DDS, PC | Dentist | Past |
Accepting new patients |
| C.L. Kirby, DDS PLLC | Dentist | Past |
Accepting new patients |
Locations
601 N Walnut St
Jefferson, TX 75657
Phone (903) 665-3914
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 38609 | TX | Yes |
Addresses
Primary practice location
601 N Walnut St
Jefferson, TX 75657-1851
Mailing address
1306 Colgate Dr
Longview, TX 75601-4307
Phone (903) 691-3293
Other providers in Jefferson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.