Provider Demographics
NPI:1508876574
Name:MIHLE, TIMOTHY HALL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:HALL
Last Name:MIHLE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 PHYSICIANS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7349
Mailing Address - Country:US
Mailing Address - Phone:910-343-3333
Mailing Address - Fax:910-763-9476
Practice Address - Street 1:1604 PHYSICIANS DR STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7349
Practice Address - Country:US
Practice Address - Phone:910-343-3333
Practice Address - Fax:910-763-9476
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC153841OtherUNITED CONCORDIA
NC9594BOtherBCBS