Healthcare Provider Details

I. General information

NPI: 1245382787
Provider Name (Legal Business Name): DAVID HUGHES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8314 TRAFORD LANE
SPRINGFIELD VA
22152
US

IV. Provider business mailing address

8314 TRAFORD LANE
SPRINGFIELD VA
22152
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-0502
  • Fax: 703-451-8799
Mailing address:
  • Phone: 703-451-0502
  • Fax: 703-451-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401410372
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: