Provider Demographics
NPI:1598985475
Name:PUMPHREY, DAVID W
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:PUMPHREY
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 1:300 W WIEUCA RD NE
Mailing Address - Street 2:BLDG 2 SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3352
Mailing Address - Country:US
Mailing Address - Phone:404-303-1200
Mailing Address - Fax:404-303-9224
Practice Address - Street 1:300 W WIEUCA RD NE
Practice Address - Street 2:BLDG 2 SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3352
Practice Address - Country:US
Practice Address - Phone:404-303-1200
Practice Address - Fax:404-303-9224
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA99641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics