Provider Demographics
NPI:1114145745
Name:HUMBARGAR, DAVID W
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:HUMBARGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 S WADSWORTH BLVD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4899
Mailing Address - Country:US
Mailing Address - Phone:303-988-6110
Mailing Address - Fax:303-988-8307
Practice Address - Street 1:3190 S WADSWORTH BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4899
Practice Address - Country:US
Practice Address - Phone:303-988-6110
Practice Address - Fax:303-988-8307
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice