Wall, Tanya C

Wall, Tanya C is an individual health care provider with primary practice located at 2255 Dunn Ave Bldg. 700, Jacksonville FL 32218. She recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as her primary health care specialty. Wall, Tanya C can be contacted via phone (904) 751-5126.

Contact Information

Primary practice address
2255 Dunn Ave Bldg. 700 Jacksonville FL 32218
Phone: (904) 751-5126
Fax: (904) 751-5146
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X DN15601 Florida

Profile Details

NPI number 1063528586
LBN Legal business name Wall, Tanya C
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 21st, 2006
Last updated Jan 8th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063528586 NPPES
Florida Other 70640 ADI HEALTHY KIDS
Florida MEDICAID 0758264000 ADI HEALTHY KIDS

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