Provider Demographics
NPI:1336536879
Name:HORIZON DENTAL
Entity Type:Organization
Organization Name:HORIZON DENTAL
Other - Org Name:ALL ABOUT SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SALAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-981-1544
Mailing Address - Street 1:42180 FORD RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3673
Mailing Address - Country:US
Mailing Address - Phone:734-981-1199
Mailing Address - Fax:734-981-1544
Practice Address - Street 1:42180 FORD RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3673
Practice Address - Country:US
Practice Address - Phone:734-981-1199
Practice Address - Fax:734-981-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-36755998Medicaid