Organization
HORIZON DENTAL GROUP PRESCOTT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELCIE THOMPSON (BILLING MANGER)
(928) 925-6522
Entity
Organization
Contact information
Practice address
919 12TH PL, PRESCOTT, AZ 86305-1433
(928) 925-6522
(928) 636-1164
Mailing address
139 S MARINA ST, PRESCOTT, AZ 86303-3830
(928) 925-6522
(928) 636-1164
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5634
AZ
1223G0001X
General Practice Dentistry
D8489
AZ
1223G0001X
General Practice Dentistry
D8753
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
703042
—
AZ
05
—
731456
—
AZ
05
—
824155
—
AZ
Enumeration date
07/28/2015
Last updated
07/28/2015
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