Provider Demographics
NPI:1912153156
Name:DR. MICHELE S. HORTON, D.D.S.,P.C.
Entity Type:Organization
Organization Name:DR. MICHELE S. HORTON, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESSADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-377-1010
Mailing Address - Street 1:2210 DEAN ST
Mailing Address - Street 2:STE H
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1066
Mailing Address - Country:US
Mailing Address - Phone:630-377-1010
Mailing Address - Fax:630-377-1091
Practice Address - Street 1:2210 DEAN ST
Practice Address - Street 2:STE H
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1066
Practice Address - Country:US
Practice Address - Phone:630-377-1010
Practice Address - Fax:630-377-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019A020460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty