Provider Demographics
NPI:1093769481
Name:HORGAN, THOMAS JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:HORGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 CAPAC RD
Mailing Address - Street 2:
Mailing Address - City:MUSSEY
Mailing Address - State:MI
Mailing Address - Zip Code:48014-3186
Mailing Address - Country:US
Mailing Address - Phone:810-395-2100
Mailing Address - Fax:810-395-2100
Practice Address - Street 1:4309 CAPAC RD
Practice Address - Street 2:
Practice Address - City:MUSSEY
Practice Address - State:MI
Practice Address - Zip Code:48014-3186
Practice Address - Country:US
Practice Address - Phone:810-395-2100
Practice Address - Fax:810-395-2100
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0146471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice