Healthcare Provider Details

I. General information

NPI: 1609506773
Provider Name (Legal Business Name): HORSEY ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 E PARHAM RD
HENRICO VA
23228-2734
US

IV. Provider business mailing address

4106 E PARHAM RD
HENRICO VA
23228-2734
US

V. Phone/Fax

Practice location:
  • Phone: 804-672-3030
  • Fax: 804-672-3131
Mailing address:
  • Phone: 804-672-3030
  • Fax: 804-672-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GUSTAV HORSEY
Title or Position: OWNER/ORTHODONTIST
Credential: DDS, MS
Phone: 804-672-3030