Individual
DR. BRENT WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
900 THOMAS DR, PANAMA CITY BEACH, FL 32408-7442
(850) 249-9311
Mailing address
9696 BRAUN ROAD, SAN ANTONIO, TX 78254
(210) 523-9696
(210) 684-9600
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN28186
FL
1223G0001X
General Practice Dentistry
19733
TX
Other
Enumeration date
01/09/2007
Last updated
10/12/2023
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