Healthcare Provider Details

I. General information

NPI: 1699982256
Provider Name (Legal Business Name): HUGHES ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S 15TH AVE
LAUREL MS
39440-4124
US

IV. Provider business mailing address

501 AZALEA DR STE F
WAYNESBORO MS
39367-2661
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-7800
  • Fax: 601-426-6558
Mailing address:
  • Phone: 601-735-4788
  • Fax: 601-426-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberOR007777
License Number StateMS

VIII. Authorized Official

Name: DR. DAVID O HUGHES SR.
Title or Position: OWNER
Credential: DDS, MS
Phone: 601-649-7800