Provider Demographics
NPI:1609030246
Name:DOUGLAS J HORTON DDS PC
Entity Type:Organization
Organization Name:DOUGLAS J HORTON DDS PC
Other - Org Name:SIGNAL RIDGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-393-0773
Mailing Address - Street 1:4141 GLASS ROAD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402
Mailing Address - Country:US
Mailing Address - Phone:319-393-0773
Mailing Address - Fax:319-294-4423
Practice Address - Street 1:4141 GLASS ROAD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-393-0773
Practice Address - Fax:319-294-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA61741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0137794Medicaid