Horizon Dental Group LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D5634 Issued in AZ

Legal business name

HORIZON DENTAL GROUP LLC

Practice address

432 N Butterfield Rd
Chino Valley, AZ 86323

Phone

(928) 636-1565

Fax

(928) 636-1164

NPI assigned

Dec 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Anthony Costes, DDS

Title

Owner Dentist

Phone

(928) 636-1565

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1457419327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "432 N BUTTERFIELD RD",
            "city": "CHINO VALLEY",
            "state": "AZ",
            "postal_code": "86323",
            "telephone_number": "928-636-1565",
            "fax_number": "928-636-1164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "432 N BUTTERFIELD RD",
            "city": "CHINO VALLEY",
            "state": "AZ",
            "postal_code": "86323",
            "telephone_number": "928-636-1565",
            "fax_number": "928-636-1164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HORIZON DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "COSTES",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "928-636-1565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D5634",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D7056",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D6997",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACCCHS",
            "identifier": "703042",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.