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General NPI Number Information
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NPI Number | 1275227902
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Entity Type | Individual
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Provider Name | BRENT MICHAEL HUMESTON DD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE RM 20-140
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City | LOS ANGELES
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State | CA
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Zip | 90095-1446
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Country | US
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Telephone | 209-499-1179
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Fax |
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Provider Business Mailing Address
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Address Line | 10833 LE CONTE AVE RM 20-140
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City | LOS ANGELES
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State | CA
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Zip | 90095-3075
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Country | US
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Telephone | 209-499-1179
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 110229
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License Number State | CA
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