| NPI | 1689025256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW RYAN WALL Manager/Member 602-499-4044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ 7990) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2016-06-24 |