Healthcare Provider Details

I. General information

NPI: 1528172673
Provider Name (Legal Business Name): HERBERT L GUMPRIGHT JR. DDS FAGD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 MAIN STREET
BREWSTER MA
02631
US

IV. Provider business mailing address

PO BOX 1108
BREWSTER MA
02631
US

V. Phone/Fax

Practice location:
  • Phone: 508-896-5732
  • Fax: 508-896-3134
Mailing address:
  • Phone: 508-896-5732
  • Fax: 508-896-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12162
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: