Healthcare Provider Details

I. General information

NPI: 1104031848
Provider Name (Legal Business Name): JAY A HUGHES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 N MERIDIAN ST SUITE 250
INDIANAPOLIS IN
46260-1884
US

IV. Provider business mailing address

9106 N MERIDIAN ST SUITE 250
INDIANAPOLIS IN
46260-1884
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-7001
  • Fax: 317-846-7102
Mailing address:
  • Phone: 317-846-7001
  • Fax: 317-846-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12008582A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: