Provider Demographics
NPI:1114024106
Name:HAMBY, MIKE PRESTON (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:PRESTON
Last Name:HAMBY
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 DWIGHT ROWLAND RD
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7204
Mailing Address - Country:US
Mailing Address - Phone:919-552-2431
Mailing Address - Fax:919-552-9743
Practice Address - Street 1:6009 DWIGHT ROWLAND RD
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7204
Practice Address - Country:US
Practice Address - Phone:919-552-2431
Practice Address - Fax:919-552-9743
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993477Medicaid
NC135450OtherUNITED CONCORDIA
NC93477OtherBCBC PROVIDER NUMBER
NC8993477Medicaid