Provider Demographics
NPI:1578520797
Name:MOHORN, HAROLD W (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:W
Last Name:MOHORN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 BENJAMIN PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2015
Mailing Address - Country:US
Mailing Address - Phone:336-288-0010
Mailing Address - Fax:336-282-5754
Practice Address - Street 1:1602 BENJAMIN PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2015
Practice Address - Country:US
Practice Address - Phone:336-288-0010
Practice Address - Fax:336-282-5754
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996044Medicaid