Healthcare Provider Details

I. General information

NPI: 1093769481
Provider Name (Legal Business Name): THOMAS JOSEPH HORGAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 CAPAC RD
MUSSEY MI
48014-3186
US

IV. Provider business mailing address

4309 CAPAC RD
MUSSEY MI
48014-3186
US

V. Phone/Fax

Practice location:
  • Phone: 810-395-2100
  • Fax: 810-395-2100
Mailing address:
  • Phone: 810-395-2100
  • Fax: 810-395-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number014647
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: