1265986855 NPI number — MICHAEL T. HORN, DDS, PLLC

Table of content: (NPI 1265986855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265986855 NPI number — MICHAEL T. HORN, DDS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL T. HORN, DDS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRIDAY HARBOR DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265986855
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 772
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIDAY HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98250-0772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-378-4944
Provider Business Mailing Address Fax Number:
360-378-2823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRIDAY HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-378-4944
Provider Business Practice Location Address Fax Number:
360-378-2823
Provider Enumeration Date:
08/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
HIXSON
Authorized Official Title or Position:
OFFICE ADMIN/HYGIENIST
Authorized Official Telephone Number:
360-378-4944

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X , with the licence number: DE00010001 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 122300000X , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com