Individual
BRANDON HUMBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS040213
PA
390200000X
Student in an Organized Health Care Education/Training Program
390200000
PA
Other
Enumeration date
07/10/2013
Last updated
12/11/2019
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