Healthcare Provider Details

I. General information

NPI: 1164563193
Provider Name (Legal Business Name): BENJAMIN THOMAS HORGAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N MINNESOTA ST
CARSON CITY NV
89703-3954
US

IV. Provider business mailing address

725 N MINNESOTA ST
CARSON CITY NV
89703-3954
US

V. Phone/Fax

Practice location:
  • Phone: 775-883-6700
  • Fax: 775-883-6701
Mailing address:
  • Phone: 775-883-6700
  • Fax: 775-883-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4704
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: