Provider Demographics
NPI:1275658478
Name:HUGHES, GREGORY SCOTT (DMD,PC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SCOTT
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DMD,PC
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:S
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:41 ASHBY DR
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-3229
Mailing Address - Country:US
Mailing Address - Phone:540-966-0633
Mailing Address - Fax:540-366-0685
Practice Address - Street 1:2840 HERSHBERGER RD NW STE C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-1915
Practice Address - Country:US
Practice Address - Phone:540-366-8325
Practice Address - Fax:540-366-0685
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA76301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7630OtherLIC NO
VA542041901OtherTAX ID