Brent R. Humphrey DMD, P.a.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2872 Issued in SC

Legal business name

BRENT R. HUMPHREY DMD, P.A.

Practice address

103 Springhall Dr
Goose Creek, SC 29445-5336

Phone

(843) 797-2000

Fax

(843) 797-8826

NPI assigned

Aug 14, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Brent R. Humphrey, D.M.D.NPI 1831378686

Title

Owner

Phone

(843) 797-2000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brent R. Humphrey, D.M.D.

  • Pediatric Dentistry
  • Goose Creek, SC
  • NPI 1831378686
  NPD (past) Authorized official

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316950843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SPRINGHALL DR",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294455336",
            "telephone_number": "843-797-2000",
            "fax_number": "843-797-8826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SPRINGHALL DR",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294455336",
            "telephone_number": "843-797-2000",
            "fax_number": "843-797-8826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENT R. HUMPHREY DMD, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUMPHREY",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-797-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "2872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA 9522",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandy Brandfass, RN, CPM
• Kevin Branson, MA, CACP
• Steve Johnson Brasington, M.D.
• Taylor Brawner
• Abbey Caroline Bray
• Natalie Brockman
• Calonie Brooks
• Kirby Broome, PT, DPT
• Kalundia Brown, BSN RN
• Karen L Brown, LMFT, LPC

• Pediatric Dentistry in Goose Creek, SC
• Providers in Goose Creek, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.