# RIATA VALLEY DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669949582
- **Authorized official:** LEIGHANN SAMSON (MANAGER)
- **Authorized official phone:** (928) 753-5069

## Contact information

- **Practice address:** 1111 RIATA VALLEY RD STE 350, KINGMAN, AZ 86409-3719
- **Practice address phone:** (928) 757-9190
- **Mailing address:** 1720 E BEVERLY AVE, KINGMAN, AZ 86409-3567
- **Mailing address phone:** (928) 753-5069

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 10/29/2018
- **Last updated:** 10/29/2018