Provider Demographics
NPI:1508036997
Name:DR. TIMOTHY H. MIHLE
Entity Type:Organization
Organization Name:DR. TIMOTHY H. MIHLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:MIHLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-343-3333
Mailing Address - Street 1:1604 PHYSICIANS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7362
Mailing Address - Country:US
Mailing Address - Phone:910-343-3333
Mailing Address - Fax:910-763-9476
Practice Address - Street 1:1604 PHYSICIANS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7362
Practice Address - Country:US
Practice Address - Phone:910-343-3333
Practice Address - Fax:910-763-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899594BMedicaid