Provider Demographics
NPI:1457886889
Name:HORIZON RIDGE DENTAL LLC
Entity Type:Organization
Organization Name:HORIZON RIDGE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:ENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-628-2667
Mailing Address - Street 1:754 S MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5504
Mailing Address - Country:US
Mailing Address - Phone:435-628-2667
Mailing Address - Fax:435-628-6205
Practice Address - Street 1:1070 W HORIZON RIDGE PKWY
Practice Address - Street 2:STE 120
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-6016
Practice Address - Country:US
Practice Address - Phone:702-432-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0928261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental