Provider Demographics
NPI:1831304179
Name:SCOTT A HUM, DMD, PA
Entity Type:Organization
Organization Name:SCOTT A HUM, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-783-9920
Mailing Address - Street 1:2500 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6469
Mailing Address - Country:US
Mailing Address - Phone:919-783-9920
Mailing Address - Fax:919-783-7026
Practice Address - Street 1:2500 BLUE RIDGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6469
Practice Address - Country:US
Practice Address - Phone:919-783-9920
Practice Address - Fax:919-783-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994241Medicaid
NCU27621Medicare UPIN
NC8994241Medicaid