Healthcare Provider Details

I. General information

NPI: 1003685470
Provider Name (Legal Business Name): HUGHES DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20930 BONITA ST STE X
CARSON CA
90746-3682
US

IV. Provider business mailing address

20930 BONITA ST STE X
CARSON CA
90746-3682
US

V. Phone/Fax

Practice location:
  • Phone: 310-523-2161
  • Fax:
Mailing address:
  • Phone: 310-523-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRACE HUGHES
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 310-523-2161