Healthcare Provider Details

I. General information

NPI: 1295097772
Provider Name (Legal Business Name): STEPHANIE ATLAS HUKILL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 COLTSGATE RD # 204
CHARLOTTE NC
28211-3799
US

IV. Provider business mailing address

5829 PHYLISS LANE
MINT HILL NC
28227
US

V. Phone/Fax

Practice location:
  • Phone: 704-749-5700
  • Fax:
Mailing address:
  • Phone: 704-790-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019029731
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number021002594
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10304
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: