Individual provider Active NPI

Stephanie Atlas Hukill, DDS

  • Pediatric Dentistry
  • Charlotte, NC
National Provider Identifier
1295097772
Registry record updated Apr 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
10304 Issued in NC
Practice address
2700 Coltsgate Rd # 204
Charlotte, NC 28211-3799
Phone
(704) 749-5700
NPI assigned
Jun 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019029731 IL
Pediatric Dentistry 1223P0221X 021002594 IL
Pediatric Dentistry 1223P0221X 10304 NC Primary

Addresses

Primary practice location

2700 Coltsgate Rd # 204
Charlotte, NC 28211-3799

Mailing address

5829 Phyliss Lane
Mint Hill, NC 28227
Phone (704) 790-0590

Other practice location 1

5829 Phyliss Lane
Mint Hill, NC 28227
Phone (704) 790-0590

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
10304NCMDCounselor
019029731ILMDDentist
021002594ILMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Rea Farms Pediatric Dentistry Partnership Pediatric Dentistry Current Accepting new patients
Londry, Modlin, Tucker III DDS PLLC Dentist PastSince Apr 21, 2024 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554940800000",
    "number": "1295097772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5829 PHYLISS LANE",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "28227",
            "telephone_number": "704-790-0590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 COLTSGATE RD # 204",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282113799",
            "telephone_number": "704-749-5700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5829 Phyliss Lane",
            "address_purpose": "LOCATION",
            "city": "Mint Hill",
            "state": "NC",
            "postal_code": "28227",
            "country_code": "US",
            "telephone_number": "704-790-0590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUKILL",
        "first_name": "STEPHANIE",
        "middle_name": "ATLAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-12",
        "last_updated": "2019-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029731",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "021002594",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "10304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.