Provider Demographics
NPI:1336150549
Name:HUMPHRIES, JAMES WALLACE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALLACE
Last Name:HUMPHRIES
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:HUMPHRIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2711 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-6309
Mailing Address - Country:US
Mailing Address - Phone:979-245-6541
Mailing Address - Fax:979-245-0118
Practice Address - Street 1:2711 4TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-6309
Practice Address - Country:US
Practice Address - Phone:979-245-6541
Practice Address - Fax:979-245-0118
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice