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General NPI Number Information
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NPI Number | 1851034169
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Entity Type | Organization
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Legal Business Name | LAUREN HUMPHREYS, D.D.S., P.A.
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 14595 PHILIPS HWY # 1
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3709
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Country | US
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Telephone | 904-290-8766
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Fax |
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Provider Business Mailing Address
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Address Line | 418 SKATE RD
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-3822
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Country | US
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Telephone | 850-814-2587
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAUREN ANTONIA HUMPHREYS
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Credential | DDS
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Telephone | 850-814-2587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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