Matthew Ryan Wall, D.D.S.

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

License

D7990 Issued in AZ

Practice address

625 W Southern Ave Ste E-145
Mesa, AZ 85210-5030

Phone

(602) 759-2131

NPI assigned

Dec 18, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Paradigm Anesthesia LLC

  • Anesthesiology Physician
  • Peoria, AZ
  • NPI 1518603968
  NPD Authorized official
• Arizona Dental Anesthesia PLLC

  • Dental Anesthesiology
  • Peoria, AZ
  • NPI 1689025256
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467158400000",
    "number": "1629214820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 W SOUTHERN AVE STE E-145",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105030",
            "telephone_number": "602-759-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 W SOUTHERN AVE STE E-145",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105030",
            "telephone_number": "602-759-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "MATTHEW",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-18",
        "last_updated": "2016-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "57242",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "AZ",
            "license": "D7990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "535955",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Scott Walker, P.T.
• Sheri Dee Walker
• Stephen L. Walker, DDS, MS
• Timothy Ellis Walker, M.D.
• Brandon Wall
• Wallace Chiropractic, PC
• Kristine Wallace, N.D.
• Peggy Ann Wallace, LPN
• Ryan Scott Wallin, DDS
• Harvey W Wallmann, PT, DSC

• Dental Anesthesiology in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Dental Anesthesiology in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.