Active NPI
Mitra Darice Waite, DMD, PHD
- Dentist
- Madison, AL
National Provider Identifier
1619497989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6424
- Practice address
- 20 Hughes Rd
Suite 104
Madison, AL 35758 - Phone
- (256) 864-9571
- Fax
- (866) 803-4943
- NPI assigned
- Jun 27, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6424 | AL | Primary |
Addresses
Primary practice location
20 Hughes Rd
Suite 104
Madison, AL 35758
Mailing address
728 Flag Cir
Hoover, AL 35226-4917
Phone (256) 479-8490
Other names 1
- Ms. Mitra Darice Adhami
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171009002069 | AL | Order and Referring Only - Other (Physician) | 9638444177 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6424 | AL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769126400000",
"number": "1619497989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "728 FLAG CIR",
"city": "HOOVER",
"state": "AL",
"postal_code": "352264917",
"telephone_number": "256-479-8490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 HUGHES RD",
"address_2": "SUITE 104",
"city": "MADISON",
"state": "AL",
"postal_code": "35758",
"telephone_number": "256-864-9571",
"fax_number": "866-803-4943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAITE",
"first_name": "MITRA",
"middle_name": "DARICE",
"name_prefix": "Mrs.",
"credential": "DMD, PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-27",
"last_updated": "2026-01-23",
"certification_date": "2026-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "AL",
"license": "6424",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MITRA",
"last_name": "ADHAMI",
"middle_name": "DARICE",
"prefix": "MS.",
"credential": "DMD, PHD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Madison, AL
- Larae A Wade, LICSW-S
- Robert P Wade Jr., RPH
- Jamey Paul Wagner, D.C.
- Waite Rehab & Wellness
- Holly E. Waite, MPT
- Scott A. Waite, P.T.
- Wal-Mart Stores East LP (Walmart Pharmacy 10-7342)
- Wal-Mart Stores East LP (Walmart Pharmacy 10-5746)
- Wal-Mart Stores East LP (WalMart Pharmacy 10-5703)
- Wal-Mart Stores East LP (Walmart Pharmacy 10-2690)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.