Provider Demographics
NPI:1871689786
Name:HUME, GRACE-MARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRACE-MARY
Middle Name:
Last Name:HUME
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 SAN MIGUEL DR
Mailing Address - Street 2:STE. 27
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5279
Mailing Address - Country:US
Mailing Address - Phone:925-944-5151
Mailing Address - Fax:925-944-0189
Practice Address - Street 1:1855 SAN MIGUEL DR
Practice Address - Street 2:STE. 27
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5279
Practice Address - Country:US
Practice Address - Phone:925-944-5151
Practice Address - Fax:925-944-0189
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB355051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice