MEDICARE: DR. DESTANEE BROOKE HUGHES DMD

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	1223G0001X	General Practice Dentistry	6806	LA

General Provider Information

NPI Number	:	1720500853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DESTANEE BROOKE HUGHES DMD

Provider Business Mailing Address
First Line	:	25876 OAKLEY AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-6220
Country	:	US
Telephone Number	:	225-931-6197
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 S RANGE AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4810
Country	:	US
Telephone Number	:	225-664-7771
Fax Number	:	225-667-3285

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

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	07/11/2017

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