Provider Demographics
NPI:1154308393
Name:HUMPHREY, DAUNE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAUNE
Middle Name:C
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12795
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2795
Mailing Address - Country:US
Mailing Address - Phone:252-637-8111
Mailing Address - Fax:252-637-9840
Practice Address - Street 1:1916 S GLENBURNIE RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562
Practice Address - Country:US
Practice Address - Phone:252-637-8111
Practice Address - Fax:252-637-9840
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC6044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994265Medicaid
NC94265OtherBC/BS