Individual
BRENT R. HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
103 SPRING HALL DR, GOOSE CREEK, SC 29445-5336
(843) 797-2000
(843) 797-8826
Mailing address
103 SPRING HALL 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
—
Z2872-9
—
SC
Enumeration date
10/29/2007
Last updated
10/29/2007
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