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General NPI Number Information
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NPI Number | 1679866321
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Entity Type | Organization
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Legal Business Name | HORIZON CENTER FOR PROGRESSIVE DENTISTRY P. C.
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 11/02/2014
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Provider Practice Location Address
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Address Line | 6314 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60659-1204
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Country | US
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Telephone | 773-509-0029
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Fax | 773-509-0733
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Provider Business Mailing Address
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Address Line | 6314 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60659-1204
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Country | US
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Telephone | 773-509-0029
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Fax | 773-509-0733
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL SANIUK
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Credential | D.D.S.
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Telephone | 773-509-0029
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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 | 019017944
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License Number State | IL
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