Provider Demographics
NPI:1326408519
Name:HORIZON DENTAL CARE AT STEAMTOWN
Entity Type:Organization
Organization Name:HORIZON DENTAL CARE AT STEAMTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANISH
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-342-8800
Mailing Address - Street 1:400 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1238
Mailing Address - Country:US
Mailing Address - Phone:570-342-8800
Mailing Address - Fax:
Practice Address - Street 1:400 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1238
Practice Address - Country:US
Practice Address - Phone:570-342-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028534122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty