Provider Demographics
NPI:1376291617
Name:HUGHES, MICHELLE VALERIE (DMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VALERIE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WELLMAN ST APT 404
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-5169
Mailing Address - Country:US
Mailing Address - Phone:781-572-9443
Mailing Address - Fax:
Practice Address - Street 1:10 DOANE ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7405
Practice Address - Country:US
Practice Address - Phone:978-372-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
MADN1859716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty