Provider Demographics
NPI:1851474233
Name:HUMPHREYS, LEWIS GILBERT JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:GILBERT
Last Name:HUMPHREYS
Suffix:JR
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 1:102 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6902
Mailing Address - Country:US
Mailing Address - Phone:334-792-7888
Mailing Address - Fax:334-792-8717
Practice Address - Street 1:102 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-6902
Practice Address - Country:US
Practice Address - Phone:334-792-7888
Practice Address - Fax:334-792-8717
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics