# HORIZON DENTAL GROUP LLC

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

## Provider details

- **NPI number:** 1457419327
- **Authorized official:** DR. MARK ANTHONY COSTES DDS (OWNER DENTIST)
- **Authorized official phone:** (928) 636-1565

## Contact information

- **Practice address:** 432 N BUTTERFIELD RD, CHINO VALLEY, AZ 86323
- **Practice address phone:** (928) 636-1565
- **Practice address fax:** (928) 636-1164
- **Mailing address:** 432 N BUTTERFIELD RD, CHINO VALLEY, AZ 86323
- **Mailing address phone:** (928) 636-1565
- **Mailing address fax:** (928) 636-1164

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D5634 | AZ | Yes |
| 1223G0001X | General Practice Dentistry | D6997 | AZ | — |
| 1223G0001X | General Practice Dentistry | D7056 | AZ | — |

## Other

- **Enumeration date:** 12/04/2006
- **Last updated:** 06/29/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 703042 | ACCCHS | AZ |