Healthcare Provider Details

I. General information

NPI: 1164883625
Provider Name (Legal Business Name): LISA HUGHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 CENTER RD
BUFFALO NY
14224-2313
US

IV. Provider business mailing address

PO BOX 456
NORTH TONAWANDA NY
14120-0456
US

V. Phone/Fax

Practice location:
  • Phone: 716-427-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number32214
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number059281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: