Provider Demographics
NPI:1285742361
Name:HUGHES, MICHAEL GARVEY (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GARVEY
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494
Mailing Address - Country:US
Mailing Address - Phone:715-421-1114
Mailing Address - Fax:715-421-1114
Practice Address - Street 1:1111 8TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494
Practice Address - Country:US
Practice Address - Phone:715-421-1114
Practice Address - Fax:715-421-1114
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI41161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33692000Medicaid