Provider Demographics
NPI:1861198921
Name:CL DDS PLLC
Entity type:Organization
Organization Name:CL DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-740-4757
Mailing Address - Street 1:1260 S HWY 89 STE G
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-6624
Mailing Address - Country:US
Mailing Address - Phone:928-237-1305
Mailing Address - Fax:
Practice Address - Street 1:1260 S HWY 89 STE G
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-6624
Practice Address - Country:US
Practice Address - Phone:928-237-1305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental