Provider Demographics
NPI:1194836437
Name:DR HOUSTON DAVID HUGHES - A PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:DR HOUSTON DAVID HUGHES - A PROFESSIONAL DENTAL CORP
Other - Org Name:ASSOCIATED FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSTON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-664-7771
Mailing Address - Street 1:1310 SOUTH RANGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4840
Mailing Address - Country:US
Mailing Address - Phone:225-664-7771
Mailing Address - Fax:225-667-3285
Practice Address - Street 1:1310 SOUTH RANGE AVENUE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4810
Practice Address - Country:US
Practice Address - Phone:225-664-7771
Practice Address - Fax:225-667-3285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1881813Medicaid