Provider Demographics
NPI:1700055787
Name:MIKE P. HAMBY, DDS, PA
Entity Type:Organization
Organization Name:MIKE P. HAMBY, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAMBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-552-2431
Mailing Address - Street 1:7628 PURFOY RD
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-8930
Mailing Address - Country:US
Mailing Address - Phone:919-552-2431
Mailing Address - Fax:919-552-9743
Practice Address - Street 1:7628 PURFOY RD
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-8930
Practice Address - Country:US
Practice Address - Phone:919-552-2431
Practice Address - Fax:919-552-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993477Medicaid
NC135450OtherUNITED CONCORDIA
NC93477OtherBCBS