Provider Demographics
NPI:1053421479
Name:HUGHES, DOUGLAS B (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-2947
Mailing Address - Country:US
Mailing Address - Phone:307-746-9963
Mailing Address - Fax:
Practice Address - Street 1:17 S SENECA AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2816
Practice Address - Country:US
Practice Address - Phone:307-746-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice