Provider Demographics
NPI:1063635068
Name:HARRY HUMPHREYS DDS INC.
Entity Type:Organization
Organization Name:HARRY HUMPHREYS DDS INC.
Other - Org Name:NA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-845-2246
Mailing Address - Street 1:8003 ALICANTE AVE
Mailing Address - Street 2:
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241-1712
Mailing Address - Country:US
Mailing Address - Phone:661-845-2246
Mailing Address - Fax:661-845-2248
Practice Address - Street 1:8003 ALICANTE AVE
Practice Address - Street 2:
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241-1712
Practice Address - Country:US
Practice Address - Phone:661-845-2246
Practice Address - Fax:661-845-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17937122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty