Provider Demographics
NPI:1679866321
Name:HORIZON CENTER FOR PROGRESSIVE DENTISTRY P. C.
Entity Type:Organization
Organization Name:HORIZON CENTER FOR PROGRESSIVE DENTISTRY P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANIUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-509-0029
Mailing Address - Street 1:6314 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1204
Mailing Address - Country:US
Mailing Address - Phone:773-509-0029
Mailing Address - Fax:773-509-0733
Practice Address - Street 1:6314 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1204
Practice Address - Country:US
Practice Address - Phone:773-509-0029
Practice Address - Fax:773-509-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2014-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190179441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019017944OtherLICENSED DENTIST
IL1073655213OtherINDIVIDUAL NPI