Provider Demographics
NPI:1275558504
Name:DHULAB, MITESH B (DMD)
Entity Type:Individual
Prefix:
First Name:MITESH
Middle Name:B
Last Name:DHULAB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15050 IDLEWILD RD.
Mailing Address - Street 2:SUITE F AND G
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-3653
Mailing Address - Country:US
Mailing Address - Phone:704-893-0351
Mailing Address - Fax:704-893-0354
Practice Address - Street 1:15060 IDLEWILD RD
Practice Address - Street 2:STE. F AND G
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-3653
Practice Address - Country:US
Practice Address - Phone:704-893-0351
Practice Address - Fax:704-893-0354
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC-74241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice