Provider Demographics
NPI:1124236047
Name:FUQUA, THOMAS HUGHES JR (DDS,MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HUGHES
Last Name:FUQUA
Suffix:JR
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 N DEAN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4027
Mailing Address - Country:US
Mailing Address - Phone:334-749-3436
Mailing Address - Fax:334-749-3223
Practice Address - Street 1:747 N DEAN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4027
Practice Address - Country:US
Practice Address - Phone:334-749-3436
Practice Address - Fax:334-749-3223
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD52781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery