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Organization
BRENT R. HUMPHREY DMD, P.A.
Active
Organization
BRENT R. HUMPHREY DMD, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT R. HUMPHREY D.M.D. (OWNER)
(843) 797-2000
Entity
Organization
Contact information
Practice address
103 SPRINGHALL DR, GOOSE CREEK, SC 29445-5336
(843) 797-2000
(843) 797-8826
Mailing address
103 SPRINGHALL DR, GOOSE CREEK, SC 29445-5336
(843) 797-2000
(843) 797-8826
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2872
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA 9522
—
SC
Enumeration date
08/14/2006
Last updated
08/22/2020
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