MEDICARE: DOUGLAS JOHN HUGHES DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401412532	VA
2	1223G0001X	General Practice Dentistry	0401005733	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	095568	OTHER	VA	ANTHEM BLUE CROSS BLUE SHIELD
2	545504	OTHER	VA	UNITED CONCORDIA COMPANY INC

General Provider Information

NPI Number	:	1316175383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS JOHN HUGHES DDS PC

Provider Business Mailing Address
First Line	:	1542 E BAYVIEW BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-3255
Country	:	US
Telephone Number	:	757-583-1212
Fax Number	:	757-583-4722

Provider Business Practice Location Address
First Line	:	1542 E BAYVIEW BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-3255
Country	:	US
Telephone Number	:	757-583-1212
Fax Number	:	757-583-4722

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS JOHN HUGHES
Credential	:	DDS
Telephone Number	:	757-583-1212

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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