Individual
DR. JEFFREY WADE HUMBERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
11810
MD
1223P0221X
Pediatric Dentistry
Primary
DD2156
NM
1223P0221X
Pediatric Dentistry
DEN.00203125
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000A9157
—
NM
Enumeration date
10/12/2005
Last updated
02/13/2019
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