Provider Demographics
NPI:1508861162
Name:HUGHES, TRACEY RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:RAY
Last Name:HUGHES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OAK LEAF LN
Mailing Address - Street 2:APT 209
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:720-335-3566
Mailing Address - Fax:303-666-0652
Practice Address - Street 1:825 S WAUKEGAN RD
Practice Address - Street 2:STE A1
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045
Practice Address - Country:US
Practice Address - Phone:547-234-4800
Practice Address - Fax:303-666-0652
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02450351223G0001X
CO9380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice