Provider Demographics
NPI:1538205109
Name:HORLICK, ALAN STUART (DDS PC)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:STUART
Last Name:HORLICK
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6572 HIGHWAY 92
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102
Mailing Address - Country:US
Mailing Address - Phone:770-591-8446
Mailing Address - Fax:770-516-0871
Practice Address - Street 1:6572 HIGHWAY 92
Practice Address - Street 2:SUITE 120
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102
Practice Address - Country:US
Practice Address - Phone:770-591-8446
Practice Address - Fax:770-516-0871
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA9740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist