# BRENT R. HUMPHREY DMD, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316950843
- **Authorized official:** DR. BRENT R. HUMPHREY D.M.D. (OWNER)
- **Authorized official phone:** (843) 797-2000

## Contact information

- **Practice address:** 103 SPRINGHALL DR, GOOSE CREEK, SC 29445-5336
- **Practice address phone:** (843) 797-2000
- **Practice address fax:** (843) 797-8826
- **Mailing address:** 103 SPRINGHALL DR, GOOSE CREEK, SC 29445-5336
- **Mailing address phone:** (843) 797-2000
- **Mailing address fax:** (843) 797-8826

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 2872 | SC | Yes |

## Other

- **Enumeration date:** 08/14/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZA 9522 | — | SC |