Individual
DR. DEREK HEATH WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
801 OHIO AVENUE, LYNN HAVEN, FL 32444
(850) 265-3696
Mailing address
801 OHIO AVENUE, LYNN HAVEN, FL 32444
(850) 265-3696
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN14056
FL
Other
Enumeration date
11/02/2006
Last updated
07/08/2007
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