Healthcare Provider Details

I. General information

NPI: 1972581650
Provider Name (Legal Business Name): JAMES R HUGHES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 19TH AVE SW
WILLMAR MN
56201
US

IV. Provider business mailing address

1029 19TH AVE SW
WILLMAR MN
56201
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-1803
  • Fax: 320-235-6097
Mailing address:
  • Phone: 320-235-1803
  • Fax: 320-235-6097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD10815
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: