Provider Demographics
NPI:1881063477
Name:HORESH, ETTIE (DMD)
Entity type:Individual
Prefix:DR
First Name:ETTIE
Middle Name:
Last Name:HORESH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 W SUNRISE BLVD
Mailing Address - Street 2:SUITE F222
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-4020
Mailing Address - Country:US
Mailing Address - Phone:954-846-7171
Mailing Address - Fax:
Practice Address - Street 1:12801 W SUNRISE BLVD
Practice Address - Street 2:SUITE F222
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-4020
Practice Address - Country:US
Practice Address - Phone:954-846-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist