Provider Demographics
NPI:1720183585
Name:HORIZON DENTAL OF TAYLORSVILLE
Entity Type:Organization
Organization Name:HORIZON DENTAL OF TAYLORSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:E
Authorized Official - Middle Name:KASE
Authorized Official - Last Name:PEERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-561-8490
Mailing Address - Street 1:2195 W 5400 S
Mailing Address - Street 2:#203
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-1431
Mailing Address - Country:US
Mailing Address - Phone:801-969-6740
Mailing Address - Fax:801-955-5788
Practice Address - Street 1:2195 W 5400 S
Practice Address - Street 2:#203
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-1431
Practice Address - Country:US
Practice Address - Phone:801-969-6740
Practice Address - Fax:801-955-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59997171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty