Provider Demographics
NPI:1063577583
Name:HORASANIAN, MICHAEL CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:HORASANIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44508 HWY 49 SOUTH
Mailing Address - Street 2:
Mailing Address - City:AHWAHNEE
Mailing Address - State:CA
Mailing Address - Zip Code:93601
Mailing Address - Country:US
Mailing Address - Phone:559-683-3449
Mailing Address - Fax:
Practice Address - Street 1:39735 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9321
Practice Address - Country:US
Practice Address - Phone:559-683-4691
Practice Address - Fax:559-642-4375
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0367691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice