=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568536795
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER H HUGHES DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 504 RUSHING DR
-----------------------------------------------------
City | HERRIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62948-3748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-993-3100
-----------------------------------------------------
Fax | 618-993-3266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 504 RUSHING DR
-----------------------------------------------------
City | HERRIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62948-3748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-993-3100
-----------------------------------------------------
Fax | 618-993-3266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 19021787
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------