Organization
RIATA VALLEY DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEIGHANN SAMSON (MANAGER)
(928) 753-5069
Entity
Organization
Contact information
Practice address
1111 RIATA VALLEY RD STE 350, KINGMAN, AZ 86409-3719
(928) 757-9190
Mailing address
1720 E BEVERLY AVE, KINGMAN, AZ 86409-3567
(928) 753-5069
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/29/2018
Last updated
10/29/2018
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