Provider Demographics
NPI:1730230046
Name:HORTON, STEPHEN ROSS (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROSS
Last Name:HORTON
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 1:421 BARONY ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3145
Mailing Address - Country:US
Mailing Address - Phone:843-761-7110
Mailing Address - Fax:843-761-2913
Practice Address - Street 1:421 BARONY ST
Practice Address - Street 2:SUITE 7
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3145
Practice Address - Country:US
Practice Address - Phone:843-761-7110
Practice Address - Fax:843-761-2913
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25001223G0001X
SC26541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2500Medicaid
SC2654Medicaid