Provider Demographics
NPI:1447272711
Name:HORTON, MICHELE SHELY (DDS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:SHELY
Last Name:HORTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 DEAN ST
Mailing Address - Street 2:SUITE #H
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1066
Mailing Address - Country:US
Mailing Address - Phone:630-377-1010
Mailing Address - Fax:630-377-1091
Practice Address - Street 1:2210 DEAN ST
Practice Address - Street 2:SUITE #H
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1066
Practice Address - Country:US
Practice Address - Phone:630-377-1010
Practice Address - Fax:630-377-1091
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist