# HORIZON DENTAL GROUP PRESCOTT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063897411
- **Authorized official:** MRS. KELCIE THOMPSON (BILLING MANGER)
- **Authorized official phone:** (928) 925-6522

## Contact information

- **Practice address:** 919 12TH PL, PRESCOTT, AZ 86305-1433
- **Practice address phone:** (928) 925-6522
- **Practice address fax:** (928) 636-1164
- **Mailing address:** 139 S MARINA ST, PRESCOTT, AZ 86303-3830
- **Mailing address phone:** (928) 925-6522
- **Mailing address fax:** (928) 636-1164

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D5634 | AZ | Yes |
| 1223G0001X | General Practice Dentistry | D8489 | AZ | — |
| 1223G0001X | General Practice Dentistry | D8753 | AZ | — |

## Other

- **Enumeration date:** 07/28/2015
- **Last updated:** 07/28/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 703042 | — | AZ |
| 05 | — | 731456 | — | AZ |
| 05 | — | 824155 | — | AZ |