Organization
ARIZONA DENTAL ANESTHESIA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW RYAN WALL DDS (MANAGER/MEMBER)
(602) 499-4044
Entity
Organization
Contact information
Practice address
14100 N 83RD AVE STE 280, PEORIA, AZ 85381-5660
(602) 499-4044
Mailing address
14100 N 83RD AVE STE 280, PEORIA, AZ 85381-5660
(602) 499-4044
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
7990
AZ
Other
Enumeration date
06/24/2016
Last updated
06/24/2016
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