Provider Demographics
NPI:1508929746
Name:WAID, DARRYL LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:LYNN
Last Name:WAID
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-0669
Mailing Address - Country:US
Mailing Address - Phone:205-988-4488
Mailing Address - Fax:205-988-8815
Practice Address - Street 1:102 HILLTOP BUSINESS CTR. DR.
Practice Address - Street 2:STE. B
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124
Practice Address - Country:US
Practice Address - Phone:205-988-4488
Practice Address - Fax:205-988-8815
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51522827OtherBLUE CROSS BLUE SHIELD AL