Individual
DR. MATTHEW RYAN WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
625 W SOUTHERN AVE STE E-145, MESA, AZ 85210-5030
(602) 759-2131
Mailing address
625 W SOUTHERN AVE STE E-145, MESA, AZ 85210-5030
(602) 759-2131
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
57242
CA
1223D0004X
Dental Anesthesiology
Primary
D7990
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
535955
—
AZ
Enumeration date
12/18/2008
Last updated
06/29/2016
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