=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134879844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLINE HAWKINS MCCUMBEE DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2022
-----------------------------------------------------
Last Update Date | 08/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 S HAWTHORNE ST
-----------------------------------------------------
City | MOUNT HOLLY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28120-1643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-648-9444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 123 CREST ST
-----------------------------------------------------
City | MOUNT HOLLY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28120-1630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-648-9444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12770
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------