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General NPI Number Information
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NPI Number | 1134248628
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Entity Type | Individual
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Provider Name | DANIEL ALBERT HUMISTON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1337 N TAYLOR DR
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3012
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Country | US
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Telephone | 920-452-4688
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Fax |
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Provider Business Mailing Address
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Address Line | 1438 NORTH LN
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City | SHEBOYGAN
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State | WI
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Zip | 53083-2240
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Country | US
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Telephone | 920-452-0357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3227
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License Number State | WI
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