Provider Demographics
NPI:1407910474
Name:HUGHES, MARK BRIAN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRIAN
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 1:6591 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3716
Mailing Address - Country:US
Mailing Address - Phone:623-776-1113
Mailing Address - Fax:
Practice Address - Street 1:6591 W THUNDERBIRD RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3716
Practice Address - Country:US
Practice Address - Phone:623-776-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice