Provider Demographics
NPI:1700159795
Name:WILLIAM G. HORBALY, D.D.S., M.S., M.D.S.
Entity Type:Organization
Organization Name:WILLIAM G. HORBALY, D.D.S., M.S., M.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HORBALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, MDS
Authorized Official - Phone:434-973-6542
Mailing Address - Street 1:240 HYDRAULIC RIDGE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8130
Mailing Address - Country:US
Mailing Address - Phone:434-973-6542
Mailing Address - Fax:434-973-6962
Practice Address - Street 1:240 HYDRAULIC RIDGE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8130
Practice Address - Country:US
Practice Address - Phone:434-973-6542
Practice Address - Fax:434-973-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty