| Brent R. Humphrey Dmd, P.a. | |
|
103 Springhall Dr Goose Creek SC 29445-5336 | |
| (843) 797-2000 | |
| (843) 797-8826 |
| Full Name | Brent R. Humphrey Dmd, P.a. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 103 Springhall Dr, Goose Creek, South Carolina |
| Authorized Official Name and Position | Brent R. Humphrey (OWNER) |
| Authorized Official Contact | 8437972000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brent R. Humphrey Dmd, P.a. 103 Springhall Dr Goose Creek SC 29445-5336 Ph: (843) 797-2000 | Brent R. Humphrey Dmd, P.a. 103 Springhall Dr Goose Creek SC 29445-5336 Ph: (843) 797-2000 |
| NPI Number | 1316950843 |
|---|---|
| Provider Enumeration Date | 08/14/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316950843 | NPI | - | NPPES |
| ZA 9522 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 2872 (South Carolina) | Primary |
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