Individual
DR. MARK HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
8657 OLD BONHOMME RD, SAINT LOUIS, MO 63132-3901
(636) 734-6896
Mailing address
8657 OLD BONHOMME RD, SAINT LOUIS, MO 63132-3901
(636) 734-6896
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2014016805
MO
Other
Enumeration date
02/01/2017
Last updated
02/01/2017
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