Provider Demographics
NPI:1114441995
Name:KELLY HUGHES, DMD, LLC
Entity Type:Organization
Organization Name:KELLY HUGHES, DMD, LLC
Other - Org Name:SOUTHERN SMILES PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-399-8601
Mailing Address - Street 1:400 TOWN PARK BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3471
Mailing Address - Country:US
Mailing Address - Phone:706-288-1100
Mailing Address - Fax:706-288-1060
Practice Address - Street 1:400 TOWN PARK BLVD STE 400
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3471
Practice Address - Country:US
Practice Address - Phone:706-288-1100
Practice Address - Fax:706-288-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0127691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty