Provider Demographics
NPI:1851698013
Name:HUME, MITCHELL DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:DOUGLAS
Last Name:HUME
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 1:1438 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1544
Mailing Address - Country:US
Mailing Address - Phone:704-332-5089
Mailing Address - Fax:704-332-5052
Practice Address - Street 1:225 NORTH TORRENCE STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28056-1544
Practice Address - Country:US
Practice Address - Phone:704-332-5089
Practice Address - Fax:704-332-5052
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC621833084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist