1194836437 NPI number — DR HOUSTON DAVID HUGHES - A PROFESSIONAL DENTAL CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194836437 NPI number — DR HOUSTON DAVID HUGHES - A PROFESSIONAL DENTAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR HOUSTON DAVID HUGHES - A PROFESSIONAL DENTAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194836437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 SOUTH RANGE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENHAM SPRINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70726-4840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-664-7771
Provider Business Mailing Address Fax Number:
225-667-3285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 SOUTH RANGE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70726-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-664-7771
Provider Business Practice Location Address Fax Number:
225-667-3285
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
HOUSTON
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
225-664-7771

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2291 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1881813 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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