Organization
HUMPHREYS FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL C. HUMPHREYS D.M.D. (OWNER/DENTIST)
(601) 450-3368
Entity
Organization
Contact information
Practice address
16 OFFICE PARK DR, SUITE 1, HATTIESBURG, MS 39402-6020
(601) 450-3368
(601) 450-3370
Mailing address
16 OFFICE PARK DR, SUITE 1, HATTIESBURG, MS 39402-6020
(601) 450-3368
(601) 450-3370
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3329-05
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08902788
—
MS
Enumeration date
12/13/2007
Last updated
12/13/2007
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