Provider Demographics
NPI:1750963344
Name:ALISHA F. HUMBLE DMD PLLC
Entity type:Organization
Organization Name:ALISHA F. HUMBLE DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-642-5276
Mailing Address - Street 1:4635 HILLSBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2343
Mailing Address - Country:US
Mailing Address - Phone:919-383-3882
Mailing Address - Fax:
Practice Address - Street 1:4635 HILLSBOROUGH RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2343
Practice Address - Country:US
Practice Address - Phone:919-383-3882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental