Healthcare Provider Details

I. General information

NPI: 1821212994
Provider Name (Legal Business Name): EDUARDO HUMES DDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7217 HAWKINS VIEW DR SUITE 200
FORT WORTH TX
76132-3927
US

IV. Provider business mailing address

7217 HAWKINS VIEW DR SUITE 200
FORT WORTH TX
76132-3927
US

V. Phone/Fax

Practice location:
  • Phone: 817-292-3605
  • Fax: 817-292-1743
Mailing address:
  • Phone: 817-292-3605
  • Fax: 817-292-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number23154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: