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General NPI Number Information
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NPI Number | 1063577583
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Entity Type | Individual
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Provider Name | MICHAEL CHARLES HORASANIAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 39735 EVERGREEN DR
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City | OAKHURST
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State | CA
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Zip | 93644-9321
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Country | US
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Telephone | 559-683-4691
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Fax | 559-642-4375
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Provider Business Mailing Address
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Address Line | 44508 HWY 49 SOUTH
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City | AHWAHNEE
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State | CA
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Zip | 93601
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Country | US
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Telephone | 559-683-3449
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 036769
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License Number State | CA
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