MEDICARE: NEW HORIZON INSTITUTE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1720396484	OTHER		INDIVIDUAL NPI
2	1467981332	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1851887277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HORIZON INSTITUTE, INC.

Provider Business Mailing Address
First Line	:	705 COLUMBUS ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-3623
Country	:	US
Telephone Number	:	605-716-5622
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 S MCCLINTOCK DR STE 111
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-3449
Country	:	US
Telephone Number	:	480-664-2270
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUSTIN D MOODY
Credential	:	DDS
Telephone Number	:	605-716-5622

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	07/09/2018

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Directions to “NEW HORIZON INSTITUTE, INC. ” Practice Location

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