Organization
DEREK H. WALL DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK HEATH WALL DDS PA (PRESIDENT)
(850) 265-3696
Entity
Organization
Contact information
Practice address
801 OHIO AVE, LYNN HAVEN, FL 32444-2351
(850) 265-3696
(850) 265-2699
Mailing address
801 OHIO AVE, LYNN HAVEN, FL 32444-2351
(850) 265-3696
(850) 265-2699
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN14056
FL
Other
Enumeration date
08/14/2009
Last updated
08/14/2009
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