| NPI | 1346782208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN SCOTT WALLIN Owner 480-786-9030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D5282) |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2016-11-09 |