Jeffrey Wade Humberson, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DD2156 Issued in NM

Practice address

490B W Zia Rd
Santa Fe, NM 87505-7008

Phone

(505) 428-7878

NPI assigned

Oct 12, 2005

Last updated

Feb 13, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Just for Grins

  • Pediatric Dentistry
  • Santa Fe, NM
  • NPI 1801074257
  NPD (past)

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550016000000",
    "number": "1487642641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490B W ZIA RD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875057008",
            "telephone_number": "505-428-7878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490B W ZIA RD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875057008",
            "telephone_number": "505-428-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMBERSON",
        "first_name": "JEFFREY",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2019-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "DEN.00203125",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MD",
            "license": "11810",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NM",
            "license": "DD2156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000A9157",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Renea Huizenga, PT
• Ruth Lynne Hulett, D.O.M.
• Kennedy Hull
• Todd D. Hultman, CNP
• Human Performance Center, Inc (Human Performance Center)
• Hummingbird Integrative Health LLC
• James Humphrey, CRNA
• Barbara Jo Sauls Humphries
• Sheila Hundley, NP-C
• Brian L Hunt, PHARMD

• Pediatric Dentistry in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Pediatric Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2019; 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.