Individual
MRS. MICHELLE MARIE VANDERWAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
340 MAGNOLIA CIR, BLDG 1465, TYNDALL AFB, FL 32403-5604
(850) 283-7574
Mailing address
926 LEE CT, PANAMA CITY, FL 32404-9661
(850) 215-7585
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH 18089
FL
Other
Enumeration date
01/12/2007
Last updated
07/08/2007
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