Healthcare Provider Details

I. General information

NPI: 1235807520
Provider Name (Legal Business Name): MITCHELL HINES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12450 CLEVELAND RD STE 100
GARNER NC
27529-8355
US

IV. Provider business mailing address

4035 PINE ARCH WAY
NEW HILL NC
27562-9623
US

V. Phone/Fax

Practice location:
  • Phone: 919-772-9927
  • Fax:
Mailing address:
  • Phone: 919-816-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12445
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: