Healthcare Provider Details

I. General information

NPI: 1740470574
Provider Name (Legal Business Name): DIANE HUGHES D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401-D CABEZON BOULEVARD
RIO RANCHO NM
87124
US

IV. Provider business mailing address

4901 LARCHMONT DR NE
ALBUQUERQUE NM
87111-2938
US

V. Phone/Fax

Practice location:
  • Phone: 505-271-0305
  • Fax: 505-899-6980
Mailing address:
  • Phone: 505-271-0305
  • Fax: 505-899-6980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDD2972
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number046250
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: