Individual
MRS. MITRA DARICE WAITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD, PHD
Contact information
Practice address
20 HUGHES RD, SUITE 104, MADISON, AL 35758
(256) 864-9571
(866) 803-4943
Mailing address
728 FLAG CIR, HOOVER, AL 35226-4917
(256) 479-8490
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6424
AL
Other
Enumeration date
06/27/2017
Last updated
01/23/2026
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