Healthcare Provider Details

I. General information

NPI: 1740216456
Provider Name (Legal Business Name): SCOTT ALAN HUM DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BLUE RIDGE RD SUITE 201
RALEIGH NC
27607-6469
US

IV. Provider business mailing address

2500 BLUE RIDGE RD SUITE 201
RALEIGH NC
27607-6469
US

V. Phone/Fax

Practice location:
  • Phone: 919-783-9920
  • Fax: 919-783-7026
Mailing address:
  • Phone: 919-783-9920
  • Fax: 919-783-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5918
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: