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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