Healthcare Provider Details

I. General information

NPI: 1922855352
Provider Name (Legal Business Name): KENISE S HUGHES RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 NEW MEXICO AVE NW STE 323
WASHINGTON DC
20016-3624
US

IV. Provider business mailing address

11522 TIMBERBROOK DR
WALDORF MD
20601-2935
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-6333
  • Fax:
Mailing address:
  • Phone: 202-460-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHYG1001098
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: