MEDICARE: ELIZABETH ROBYN WALLMANN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D008395	AZ

General Provider Information

NPI Number	:	1851654750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ROBYN WALLMANN D.D.S.

Provider Business Mailing Address
First Line	:	20211 N 30TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4714
Country	:	US
Telephone Number	:	801-592-1857
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 W EUGIE AVE STE 206
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1258
Country	:	US
Telephone Number	:	623-299-8799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2012
Last Update Date	:	08/10/2023

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