Individual
DR. TANYA C WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2255 DUNN AVE, BLDG. 700, JACKSONVILLE, FL 32218
(904) 751-5126
(904) 751-5146
Mailing address
PO BOX 26948, JACKSONVILLE, FL 32226
(904) 751-5126
(904) 751-5146
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN15601
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0758264000
—
FL
01
—
70640
ADI HEALTHY KIDS
FL
Enumeration date
08/21/2006
Last updated
01/08/2019
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