MEDICARE: THOMAS HUGHES FUQUA JR. DDS,MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D5278	AL

General Provider Information

NPI Number	:	1124236047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS HUGHES FUQUA JR. DDS,MD

Provider Business Mailing Address
First Line	:	747 N DEAN RD
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-4027
Country	:	US
Telephone Number	:	334-749-3436
Fax Number	:	334-749-3223

Provider Business Practice Location Address
First Line	:	747 N DEAN RD
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-4027
Country	:	US
Telephone Number	:	334-749-3436
Fax Number	:	334-749-3223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/08/2016

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