Provider Demographics
NPI:1316175383
Name:DOUGLAS JOHN HUGHES DDS PC
Entity type:Organization
Organization Name:DOUGLAS JOHN HUGHES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-583-1212
Mailing Address - Street 1:1542 E BAYVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-3255
Mailing Address - Country:US
Mailing Address - Phone:757-583-1212
Mailing Address - Fax:757-583-4722
Practice Address - Street 1:1542 E BAYVIEW BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-3255
Practice Address - Country:US
Practice Address - Phone:757-583-1212
Practice Address - Fax:757-583-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014125321223G0001X
VA04010057331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA095568OtherANTHEM BLUE CROSS BLUE SHIELD
VA545504OtherUNITED CONCORDIA COMPANY INC