Healthcare Provider Details

I. General information

NPI: 1053421479
Provider Name (Legal Business Name): DOUGLAS B. HUGHES D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 S SENECA AVE
NEWCASTLE WY
82701-2816
US

IV. Provider business mailing address

419 ELK MOUNTAIN DR
NEWCASTLE WY
82701-2947
US

V. Phone/Fax

Practice location:
  • Phone: 307-746-4772
  • Fax:
Mailing address:
  • Phone: 307-746-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number761
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: