Healthcare Provider Details

I. General information

NPI: 1831304179
Provider Name (Legal Business Name): SCOTT A HUM, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
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: DR. SCOTT A HUM
Title or Position: PRESIDENT
Credential: DMD
Phone: 919-783-9920