Provider Demographics
NPI:1750508677
Name:HUMPHREYS, MICHAEL RHETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RHETT
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4621
Mailing Address - Country:US
Mailing Address - Phone:228-875-1156
Mailing Address - Fax:
Practice Address - Street 1:649 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4621
Practice Address - Country:US
Practice Address - Phone:228-875-1156
Practice Address - Fax:
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
MS1908-801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice