DR. JEFFREY WADE HUMBERSON (NPI# 1487642641) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487642641 |
| Entity Type | Individual |
| Full Name | DR. JEFFREY WADE HUMBERSON |
| Credential | D.D.S. |
| Practice Address |
490b W Zia Rd Santa Fe NM 87505-7008 |
| Practice Telephone | 5054287878 |
| Mailing Telephone | 5054287878 |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2019-02-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DEN.00203125 | CO | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
11810 | MD | Dental Providers |
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DD2156 | NM | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 000A9157 | 05 |
| Street Address |
490B W ZIA RD |
| City | SANTA FE |
| State | NM |
| Zip Code | 87505-7008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306834676 | Elizabeth T Prishkulnik | Dentist | 490b W Zia Rd, Santa Fe, NM 87505-7008 | 2005-10-11 |
| 1558748954 | John Oberhausen | Massage Therapist | 490b W Zia Rd, Suite 4, Santa Fe, NM 87505-7008 | 2015-05-05 |
| 1053715920 | Amy Fredericks | Social Worker | 490b W Zia Rd, Suite 4, Santa Fe, NM 87505-7008 | 2014-10-21 |
| 1770982951 | St. Vincent Hospital | Family Medicine | 490b W Zia Rd, Suite 4, Santa Fe, NM 87505-7008 | 2014-08-14 |
| 1881011864 | Jeffery B Wheaton Dds Md and Associates LLC | Dentist | 490b W Zia Rd, Suite #3, Santa Fe, NM 87505-7008 | 2014-03-27 |
| 1922343110 | St. Vincent Hospital | Acupuncturist | 490b W Zia Rd, Suite 4, Santa Fe, NM 87505-7008 | 2012-11-29 |
| 1437305935 | Carey Ann Webb | Dental Hygienist | 490b W Zia Rd, Santa Fe, NM 87505-7008 | 2008-08-15 |
| 1831318906 | Dennis A. Frieder | Dentist | 490b W Zia Rd, Suite 3, Santa Fe, NM 87505-7008 | 2007-04-25 |
| 1558455923 | Douglas R Egli | Internal Medicine | 490b W Zia Rd, Santa Fe, NM 87505-7008 | 2006-10-03 |
| 1437103157 | Joseph M. Smith IIi | Surgery | 490b W Zia Rd, Suite A, Santa Fe, NM 87505-6996 | 2006-05-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154939031 | Enchanted Sky Hospice,llc | Hospice Care, Community Based | 1692b Hospital Drive, Vigil Office Building, Suite 201a, Santa Fe, NM 87505 | 2020-07-16 |
| 1700409968 | Caa Consulting, LLC | Clinic/Center | 1448 S St. Francis Drive, Santa Fe, NM 87505 | 2020-05-22 |
| 1104447093 | Dana Marie Tsyconyea Simmons | Counselor | 1640 Calle Medico, Suite E, Santa Fe, NM 87505 | 2020-05-01 |
| 1114574217 | Kumara Hampton Therapy, LLC | Counselor | 11 Calle Medico Suite 4, Santa Fe, NM 87505 | 2019-08-22 |
| 1245886977 | Caroline Ward | Technician | 513 Velarde St 513 Velarde St, Santa Fe, NM 87505 | 2019-08-19 |
| 1205490752 | Alyson Yacono | Physical Therapist | 104 Old Las Vegas Highway, Santa Fe, NM 87505 | 2019-04-30 |
| 1366919649 | Allyson Matthews | Speech-Language Pathologist | Santa Fe Public Schools Special Education Department, 1300 Camino Sierra Vista, Santa Fe, NM 87505 | 2018-10-25 |
| 1093280281 | Diamond Care Santa Fe LLC | Skilled Nursing Facility | 635 Harkle Road, Santa Fe, NM 87505 | 2018-10-04 |
| 1972087054 | Changing Woman Initiative | Advanced Practice Midwife | 460 Saint Michaels Drive, Suite 804, Santa Fe, NM 87505 | 2018-09-24 |
| 1154812782 | Heart Wing, LLC | Social Worker | 2724 Alamosa Drive, Santa Fe, NM 87505 | 2018-05-18 |
| Find all providers in zip 87505 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457773384 | Kelly Hendricks | Dentist | 1439 S Saint Francis Dr, Santa Fe, NM 87505 | 2014-01-13 |
| 1255639621 | Whole Child Dental, LLC | Dentist | 1439 S. St. Francis Dr., Santa Fe, NM 87505 | 2011-03-08 |
| 1760653265 | Michael Mason | Dentist | 1456 S Saint Francis Dr, Santa Fe, NM 87505-4038 | 2008-03-12 |
| 1780744615 | Michael H Mason Dds Pa | Dentist | 1456 St Francis, Santa Fe, NM 87505-4038 | 2006-12-11 |
| 1760400998 | Patricia Peck | Dentist | 1692 Hospital Dr Bldg B, Ste 102, Santa Fe, NM 87505-4754 | 2006-07-17 |
| 1306834676 | Elizabeth T Prishkulnik | Dentist | 490b W Zia Rd, Santa Fe, NM 87505-7008 | 2005-10-11 |
| 1386056737 | Santa Fe Children's Dentistry | Dentist | 2008 Saint Michaels Dr, Suite B, Santa Fe, NM 87505-7682 | 2014-05-20 |
| 1023320165 | Kristin Wayne Hendricks | Dentist | 2904 Rodeo Park Dr E, Suite 300b, Santa Fe, NM 87505-6305 | 2010-07-06 |
| 1720305105 | Pueblo De Ninos Dental, PC | Dentist | 3252 Cerrillos Rd Ste A, Santa Fe, NM 87507-3001 | 2010-04-26 |
| 1801074257 | Just for Grins | Dentist | 1498 S Saint Francis Dr, Santa Fe, NM 87505-4038 | 2008-02-07 |
| Find all providers in SANTA FE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.