Healthcare Provider Details

I. General information

NPI: 1720004260
Provider Name (Legal Business Name): TERRENCE L HORAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 FIDDLERS GRN UNIT 1
WAITSFIELD VT
05673-6007
US

IV. Provider business mailing address

138 FIDDLERS GRN UNIT 1
WAITSFIELD VT
05673-6007
US

V. Phone/Fax

Practice location:
  • Phone: 802-496-2524
  • Fax: 802-496-6911
Mailing address:
  • Phone: 802-496-2524
  • Fax: 802-496-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number593
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: