Provider Demographics
NPI:1528376233
Name:HORACEK DENTAL
Entity Type:Organization
Organization Name:HORACEK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HORACEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-256-3199
Mailing Address - Street 1:10340 SE DIVISION ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1269
Mailing Address - Country:US
Mailing Address - Phone:503-256-3199
Mailing Address - Fax:503-256-9383
Practice Address - Street 1:10340 SE DIVISION ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1269
Practice Address - Country:US
Practice Address - Phone:503-256-3199
Practice Address - Fax:503-256-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD88741223G0001X
ORD92421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty