Provider Demographics
NPI:1376673152
Name:HUGHES, CARROLL (DDS)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 MOHAWK ST STE 130
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1506
Mailing Address - Country:US
Mailing Address - Phone:661-835-7389
Mailing Address - Fax:661-835-0317
Practice Address - Street 1:841 MOHAWK ST STE 130
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1506
Practice Address - Country:US
Practice Address - Phone:661-835-7389
Practice Address - Fax:661-835-7389
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770142831OtherTIN
CAB3107201Medicare ID - Type UnspecifiedCHDP PROVIDER NUMBER