Mark Humphrey, D.D.S., M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

2014016805 Issued in MO

Practice address

901 Crystal Creek Pkwy
Wentzville, MO 63385-3709

Phone

(636) 332-5550

NPI assigned

Feb 1, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 1, 2017 through Mar 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Humphrey Orthodontics, LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Wentzville, MO
  • NPI 1548708308
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787875200000",
    "number": "1023556743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 CRYSTAL CREEK PKWY",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853709",
            "telephone_number": "636-332-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 CRYSTAL CREEK PKWY",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853709",
            "telephone_number": "636-332-5550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1335 Queens Ct",
            "address_purpose": "LOCATION",
            "city": "Saint Peters",
            "state": "MO",
            "postal_code": "633767356",
            "country_code": "US",
            "telephone_number": "636-332-5550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUMPHREY",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-01",
        "last_updated": "2026-08-28",
        "certification_date": "2026-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MO",
            "license": "2014016805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Thomas Hughes, LCSW
• Sara Hughes, LPC
• Chaunceia Hughley-Valentine, PHARMD
• Laurel J Hulsey
• Humphrey Orthodontics, LLC
• Audrey Hunter
• Jeffrey J Hunter, PT
• David M Ilardi, PLPC
• In Home Health, LLC
• Kristen Lynn Indelicato, LCSW, MSW

• Orthodontics and Dentofacial Orthopedics Dentistry in Wentzville, MO
• Providers in Wentzville, MO by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.