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General NPI Number Information
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NPI Number | 1356211270
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Entity Type | Organization
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Legal Business Name | MAX DENTAL LLC
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Dates
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Enumeration Date | 11/06/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 22485 E. QUEEN CREEK RD. STE 105
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City | QUEEN CREEK
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State | AZ
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Zip | 85142
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Country | US
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Telephone | 480-900-2331
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Fax | 480-218-7828
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Provider Business Mailing Address
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Address Line | 6626 E. BASELINE RD. STE 101
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City | MESA
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State | AZ
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Zip | 85206
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Country | US
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Telephone | 480-218-8800
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Fax | 480-218-7828
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | DR. RYAN SCOTT WALLIN
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Credential | DDS
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Telephone | 480-218-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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