Provider Demographics
NPI:1619096013
Name:HORIZON DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:HORIZON DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:YUDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-254-9244
Mailing Address - Street 1:72 LANDMARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-9168
Mailing Address - Country:US
Mailing Address - Phone:802-254-9244
Mailing Address - Fax:802-254-3820
Practice Address - Street 1:72 LANDMARK HILL DR
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-9168
Practice Address - Country:US
Practice Address - Phone:802-254-9244
Practice Address - Fax:802-254-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT30009991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1001769Medicaid