=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093652075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLMT ENTERPRISES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2026
-----------------------------------------------------
Last Update Date | 04/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 270 E HUNT HWY STE 14
-----------------------------------------------------
City | SAN TAN VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85143-4964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-888-2271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 270 E HUNT HWY STE 14
-----------------------------------------------------
City | SAN TAN VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85143-4964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-888-2271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | LILLIE BOWERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-200-8634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------