Organization
HUMPHREY ORTHODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK HUMPHREY D.D.S., M.S. (MANAGER)
(636) 734-6896
Entity
Organization
Contact information
Practice address
1139 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3404
(636) 332-5550
Mailing address
1139 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3404
(636) 332-5550
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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