Provider Demographics
NPI:1558351478
Name:HUGHEY, JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:HUGHEY
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 1:1808 E AZTEC AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1808 E AZTEC AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4946
Practice Address - Country:US
Practice Address - Phone:505-722-4727
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM9741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice