Provider Demographics
NPI:1851586374
Name:HORSLEY ORTHODONTICS
Entity Type:Organization
Organization Name:HORSLEY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT/FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-254-6900
Mailing Address - Street 1:3632 W. SOUTH JORDAN PARKWAY, #201
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:801-254-6900
Mailing Address - Fax:
Practice Address - Street 1:3632 W. SOUTH JORDAN PARKWAY, #201
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-254-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5666702-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty