# CL VALLEY DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CL VALLEY DENTAL LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588316806
- **Legal business name:** CL VALLEY DENTAL LLC
- **Authorized official:** ELIZABETH AVERLAR (RDH)
- **Authorized official phone:** (928) 788-3359

## Contact information

- **Practice address:** 5677 S HIGHWAY 95, FORT MOHAVE, AZ 86426-6049
- **Practice address phone:** (928) 788-3359
- **Practice address fax:** (928) 768-6412
- **Mailing address:** 5677 S HIGHWAY 95, FORT MOHAVE, AZ 86426-6049
- **Mailing address phone:** (928) 788-3359
- **Mailing address fax:** (928) 768-6412

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/19/2022
- **Last updated:** 01/20/2022