Provider Demographics
NPI:1104282797
Name:HORIZON DENTAL GROUP LLC
Entity type:Organization
Organization Name:HORIZON DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-847-5437
Mailing Address - Street 1:2900 HORIZON DR
Mailing Address - Street 2:SUITE 13
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9058
Mailing Address - Country:US
Mailing Address - Phone:501-847-5437
Mailing Address - Fax:501-847-5439
Practice Address - Street 1:2900 HORIZON DR
Practice Address - Street 2:SUITE 13
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9058
Practice Address - Country:US
Practice Address - Phone:501-847-5437
Practice Address - Fax:501-847-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR210602631Medicaid