Healthcare Provider Details

I. General information

NPI: 1154414142
Provider Name (Legal Business Name): MICHAEL THOMAS HUGHES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W FINNIE FLAT RD STE J
CAMP VERDE AZ
86322-7265
US

IV. Provider business mailing address

60 N OLD PUMPHOUSE RD
CORNVILLE AZ
86325-5704
US

V. Phone/Fax

Practice location:
  • Phone: 928-567-5249
  • Fax:
Mailing address:
  • Phone: 928-451-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6537
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: