| Humphreys Family Dental, Llc | |
|
16 Office Park Dr Suite 1 Hattiesburg MS 39402-6020 | |
| (601) 450-3368 | |
| (601) 450-3370 |
| Full Name | Humphreys Family Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 16 Office Park Dr, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Michael C. Humphreys (OWNER/DENTIST) |
| Authorized Official Contact | 6014503368 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Humphreys Family Dental, Llc 16 Office Park Dr Suite 1 Hattiesburg MS 39402-6020 Ph: (601) 450-3368 | Humphreys Family Dental, Llc 16 Office Park Dr Suite 1 Hattiesburg MS 39402-6020 Ph: (601) 450-3368 |
| NPI Number | 1265615181 |
|---|---|
| Provider Enumeration Date | 12/13/2007 |
| Last Update Date | 12/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265615181 | NPI | - | NPPES |
| 08902788 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3329-05 (Mississippi) | Primary |
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