Provider Demographics
NPI:1174640478
Name:HORSENS, RALPH LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:LEE
Last Name:HORSENS
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 1:115 ALPINE COURT
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2511
Mailing Address - Country:US
Mailing Address - Phone:715-524-4935
Mailing Address - Fax:715-524-4943
Practice Address - Street 1:115 ALPINE COURT
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2511
Practice Address - Country:US
Practice Address - Phone:715-524-4935
Practice Address - Fax:715-524-4943
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50014660151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33352900Medicaid