=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851728232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCERSBURG FAMILY DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2013
-----------------------------------------------------
Last Update Date | 10/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 LOUDON ROAD
-----------------------------------------------------
City | MERCERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-328-5700
-----------------------------------------------------
Fax | 717-328-4310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 LOUDON ROAD
-----------------------------------------------------
City | MERCERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-328-5700
-----------------------------------------------------
Fax | 717-328-4310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. JACQUELINE M HUGHES
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 717-328-5700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS029583L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------