Provider Demographics
NPI:1104191261
Name:HUGHBANKS, TASHA RAE (RDH)
Entity Type:Individual
Prefix:MS
First Name:TASHA
Middle Name:RAE
Last Name:HUGHBANKS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1315
Mailing Address - Country:US
Mailing Address - Phone:608-393-1430
Mailing Address - Fax:
Practice Address - Street 1:1906 NORTH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1148
Practice Address - Country:US
Practice Address - Phone:608-644-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10702-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist