Organization
COLUMBIA FAMILY DENTAL LLC
Active
Parent organization
MICHAEL C HUMPHREYS
Other names
Humphreys Family Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
MICHAEL C HUMPHREYS
Authorized official
MRS. TAMMY LOWRY (OFFICE MANAGER)
(601) 543-6510
Entity
Organization
Contact information
Practice address
430 BROAD ST, COLUMBIA, MS 39429-3006
(601) 543-6510
Mailing address
430 BROAD ST, COLUMBIA, MS 39429-3006
(601) 543-6510
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08902788
—
MS
Enumeration date
11/07/2018
Last updated
11/07/2018
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