Organization
HORIZON DENTAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ANTHONY COSTES DDS (OWNER DENTIST)
(928) 636-1565
Entity
Organization
Contact information
Practice address
432 N BUTTERFIELD RD, CHINO VALLEY, AZ 86323
(928) 636-1565
(928) 636-1164
Mailing address
432 N BUTTERFIELD RD, CHINO VALLEY, AZ 86323
(928) 636-1565
(928) 636-1164
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5634
AZ
1223G0001X
General Practice Dentistry
D6997
AZ
1223G0001X
General Practice Dentistry
D7056
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
703042
ACCCHS
AZ
Enumeration date
12/04/2006
Last updated
06/29/2015
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