Healthcare Provider Details

I. General information

NPI: 1851034169
Provider Name (Legal Business Name): LAUREN HUMPHREYS, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14595 PHILIPS HWY # 1
JACKSONVILLE FL
32256-3709
US

IV. Provider business mailing address

418 SKATE RD
ATLANTIC BEACH FL
32233-3822
US

V. Phone/Fax

Practice location:
  • Phone: 904-290-8766
  • Fax:
Mailing address:
  • Phone: 850-814-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. LAUREN ANTONIA HUMPHREYS
Title or Position: PRESIDENT
Credential: DDS
Phone: 850-814-2587