Provider Demographics
NPI:1023384039
Name:HORACEK, AUDREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:HORACEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:UKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:N8881 FAWN MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-8922
Mailing Address - Country:US
Mailing Address - Phone:319-573-7688
Mailing Address - Fax:
Practice Address - Street 1:210 LEONARD ST N
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1623
Practice Address - Country:US
Practice Address - Phone:608-786-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088531223G0001X
WI68661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice