Provider Demographics
NPI:1750948618
Name:HORATIO DENTAL CLINIC
Entity type:Organization
Organization Name:HORATIO DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:OMOGHIBORA
Authorized Official - Last Name:UKHUREBOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-761-6990
Mailing Address - Street 1:5036 RANDOLPH STREET
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:425-761-6990
Mailing Address - Fax:
Practice Address - Street 1:1400 N CENTER ST STE 100
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-3018
Practice Address - Country:US
Practice Address - Phone:425-761-6990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty