Provider Demographics
NPI:1669992715
Name:HUMPHREY, CAMILLE (DDS)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:MESSING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1720 E MOUNT LEMMON HWY
Mailing Address - Street 2:
Mailing Address - City:ORACLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85623-6257
Mailing Address - Country:US
Mailing Address - Phone:520-403-2051
Mailing Address - Fax:
Practice Address - Street 1:145 CRANBERRY ST.
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-1085
Practice Address - Country:US
Practice Address - Phone:520-403-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1235921223D0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK123592Medicaid