Provider Demographics
NPI:1134112287
Name:HUGHES, JACQUELINE (DDS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 5TH AVE
Mailing Address - Street 2:SUITE B-3A
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4207
Mailing Address - Country:US
Mailing Address - Phone:717-263-4462
Mailing Address - Fax:717-263-8014
Practice Address - Street 1:767 5TH AVE
Practice Address - Street 2:SUITE B-3A
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4207
Practice Address - Country:US
Practice Address - Phone:717-263-4462
Practice Address - Fax:717-263-8014
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029583L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001634104Medicaid