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General NPI Number Information
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NPI Number | 1548315591
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Entity Type | Organization
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Legal Business Name | WILLIS J PUMPHREY JR. D.D.S. P.A.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 4126 SOUTHWEST FWY SUITE #1610
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City | HOUSTON
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State | TX
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Zip | 77027-7310
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Country | US
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Telephone | 713-777-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 4126 SOUTHWEST FWY SUITE #1610
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City | HOUSTON
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State | TX
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Zip | 77027-7310
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Country | US
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Telephone | 713-777-6453
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIS J PUMPHREY JR.
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Credential | D.D.S.
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Telephone | 713-777-6453
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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 | 13017
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License Number State | TX
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