Healthcare Provider Details

I. General information

NPI: 1336522770
Provider Name (Legal Business Name): RYAN LEWIS HUMBERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 2ND ST S
NAMPA ID
83651-3837
US

IV. Provider business mailing address

607 2ND ST S
NAMPA ID
83651-3837
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-2456
  • Fax:
Mailing address:
  • Phone: 208-466-2456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-4684
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-4684
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: