Organization
HORIZON DENTAL GROUP SPRING VALLEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ANTHONY COSTES DDS (OWNER)
(928) 925-6522
Entity
Organization
Contact information
Practice address
17301 E SPRING VALLEY RD STE C, SPRING VALLEY, AZ 86333-4263
(928) 632-9099
(928) 458-7090
Mailing address
17301 E SPRING VALLEY RD STE C, SPRING VALLEY, AZ 86333-4263
(928) 632-9099
(928) 458-7090
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D5634
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
703042
—
AZ
05
—
731456
—
AZ
Enumeration date
09/07/2016
Last updated
09/07/2016
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