Healthcare Provider Details

I. General information

NPI: 1053523928
Provider Name (Legal Business Name): JULIE HUH MOL DDS, MS, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5726 FAYETTEVILLE RD SUITE 104
DURHAM NC
27713-6296
US

IV. Provider business mailing address

5726 FAYETTEVILLE RD SUITE 104
DURHAM NC
27713-6296
US

V. Phone/Fax

Practice location:
  • Phone: 919-405-7111
  • Fax: 919-405-7222
Mailing address:
  • Phone: 919-405-7111
  • Fax: 919-405-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number107467
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: