| Derek H. Wall Dds Pa | |
|
801 Ohio Ave Lynn Haven FL 32444-2351 | |
| (850) 265-3696 | |
| (850) 265-2699 |
| Full Name | Derek H. Wall Dds Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 801 Ohio Ave, Lynn Haven, Florida |
| Authorized Official Name and Position | Derek Heath Wall Dds Pa (PRESIDENT) |
| Authorized Official Contact | 8502653696 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Derek H. Wall Dds Pa 801 Ohio Ave Lynn Haven FL 32444-2351 Ph: (850) 265-3696 | Derek H. Wall Dds Pa 801 Ohio Ave Lynn Haven FL 32444-2351 Ph: (850) 265-3696 |
| NPI Number | 1255563946 |
|---|---|
| Provider Enumeration Date | 08/14/2009 |
| Last Update Date | 08/14/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255563946 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN14056 (Florida) | Primary |
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