Humberson, Jeffrey Wade

Humberson, Jeffrey Wade is an individual health care provider with primary practice located at 490B W Zia Rd , Santa Fe NM 87505-7008. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Humberson, Jeffrey Wade can be contacted via phone (505) 428-7878.

Contact Information

Primary practice address
490B W Zia Rd Santa Fe NM 87505-7008
Phone: (505) 428-7878
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X DEN.00203125 Colorado
Dental Providers / Pediatric Dentistry 1223P0221X 11810 Maryland
Dental Providers / Pediatric Dentistry 1223P0221X DD2156 New Mexico

Profile Details

NPI number 1487642641
LBN Legal business name Humberson, Jeffrey Wade
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2005
Last updated Feb 13th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487642641 NPPES
New Mexico MEDICAID 000A9157

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