1760605299 NPI number — HUGHES DENTAL GROUP

Table of content: (NPI 1760605299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760605299 NPI number — HUGHES DENTAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUGHES DENTAL GROUP
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:
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:
1760605299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10025 19TH AVE SE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98208-4275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-337-6885
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10025 19TH AVE SE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98208-4275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-337-6885
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
425-337-6885

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5357 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4253376885 . This is a "PHONE NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5357 . This is a "LICENSE NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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