| Arizona Dental Anesthesia Pllc | |
|
14100 N 83rd Ave Ste 280 Peoria AZ 85381-5660 | |
| (602) 499-4044 | |
| Not Available |
| Full Name | Arizona Dental Anesthesia Pllc |
|---|---|
| Speciality | Dentist - Dentist Anesthesiologist |
| Location | 14100 N 83rd Ave Ste 280, Peoria, Arizona |
| Authorized Official Name and Position | Matthew Ryan Wall (MANAGER/MEMBER) |
| Authorized Official Contact | 6024994044 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Arizona Dental Anesthesia Pllc 14100 N 83rd Ave Ste 280 Peoria AZ 85381-5660 Ph: (602) 499-4044 | Arizona Dental Anesthesia Pllc 14100 N 83rd Ave Ste 280 Peoria AZ 85381-5660 Ph: (602) 499-4044 |
| NPI Number | 1689025256 |
|---|---|
| Provider Enumeration Date | 06/24/2016 |
| Last Update Date | 06/24/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689025256 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0004X | Dentist - Dentist Anesthesiologist | 7990 (Arizona) | Primary |
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