Most Relevant Information
Provider Data
| NPI Number: | 1003369422 |
| Provider Name: | DERICK MAYBERRY DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 1223P0300X |
| Specialty: | Dentist |
| License Number: | 016.0123575 |
Most Important Dates
| Enumeration Date: | 08/02/2016 |
| Last Updated: | 09/01/2020 |
Provider Practice Location
113 LIELMANIS AVE
HURLBURT FIELD
FL
325445613
Practice Location Phone/Fax
| Phone: | 8508812000 |
| Fax: |
Provider Mailing Location
4320 COMMONS DR W UNIT 5305
DESTIN
FL
325418660
Provider Mailing Phone/Fax
| Phone: | 5759565112 |
| Fax: |