Provider Demographics
NPI:1679954010
Name:MCHUGH, M MAUREEN (DDS)
Entity type:Individual
Prefix:
First Name:M MAUREEN
Middle Name:
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 W FORT ST
Mailing Address - Street 2:SUITE 441202
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-3501
Mailing Address - Country:US
Mailing Address - Phone:519-919-5868
Mailing Address - Fax:
Practice Address - Street 1:33533 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3354
Practice Address - Country:US
Practice Address - Phone:888-833-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018716122300000X
MI5315015589122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist