Individual
JON RYAN WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2028 N TREKELL RD STE 107, CASA GRANDE, AZ 85122-1326
(520) 876-9955
Mailing address
3809 E YEAGER DR, GILBERT, AZ 85295-1613
(520) 424-1955
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D009781
AZ
Other
Enumeration date
07/12/2017
Last updated
07/12/2017
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