Provider Demographics
NPI:1356058507
Name:HUMMELGARD DDS LLC
Entity type:Organization
Organization Name:HUMMELGARD DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMMELGARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-913-8225
Mailing Address - Street 1:103 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2920
Mailing Address - Country:US
Mailing Address - Phone:816-364-1186
Mailing Address - Fax:
Practice Address - Street 1:103 S 36TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2920
Practice Address - Country:US
Practice Address - Phone:816-364-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental