Individual
DEREK S STALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1950 S NARCOOSSEE RD, SAINT CLOUD, FL 34771-7204
(217) 540-5100
Mailing address
3100 W ROLLING HILLS CIR APT 209, DAVIE, FL 33328-1955
(423) 677-6940
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN23428
FL
Other
Enumeration date
06/07/2018
Last updated
06/07/2018
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