Provider Demographics
NPI:1851654750
Name:WALLMANN, ELIZABETH ROBYN (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROBYN
Last Name:WALLMANN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20211 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4714
Mailing Address - Country:US
Mailing Address - Phone:801-592-1857
Mailing Address - Fax:
Practice Address - Street 1:5601 W EUGIE AVE STE 206
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1258
Practice Address - Country:US
Practice Address - Phone:623-299-8799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-17
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0083951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice