Individual
DERICK MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
(850) 881-2000
Mailing address
4320 COMMONS DR W UNIT 5305, DESTIN, FL 32541-8660
(575) 956-5112
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
016.0123575
VT
Other
Enumeration date
08/02/2016
Last updated
09/01/2020
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