Provider Demographics
NPI:1407181480
Name:HUMPHREY-DAVIS, THERYL LYNN (DDS)
Entity type:Individual
Prefix:MS
First Name:THERYL
Middle Name:LYNN
Last Name:HUMPHREY-DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 HAMPSHIRE PK.
Mailing Address - Street 2:MAURY COUNTY HEALTH DEPARTMENT
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-560-1191
Mailing Address - Fax:931-560-1119
Practice Address - Street 1:1909 HAMPHIRE PIKE
Practice Address - Street 2:MAURY COUNTY HEALTH DEPARTMENT
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-560-1191
Practice Address - Fax:931-560-1119
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist