Provider Demographics
NPI:1346692050
Name:HUGHES, SPENCER (DMD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3323
Mailing Address - Country:US
Mailing Address - Phone:801-885-6538
Mailing Address - Fax:
Practice Address - Street 1:35 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3323
Practice Address - Country:US
Practice Address - Phone:801-885-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN 11525122300000X
MT115251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist