Provider Demographics
NPI:1669824280
Name:UMPHLETT, WILL (DMD)
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:
Last Name:UMPHLETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:ELLIOTT
Other - Last Name:UMPHLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:22 EASTGATE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2318
Mailing Address - Country:US
Mailing Address - Phone:601-825-1105
Mailing Address - Fax:601-825-1984
Practice Address - Street 1:22 EASTGATE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042
Practice Address - Country:US
Practice Address - Phone:601-825-1105
Practice Address - Fax:601-825-1984
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3854-16122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist