Provider Demographics
NPI:1730466996
Name:HUGHES, GINA LOUISE SMITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:LOUISE SMITH
Last Name:HUGHES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:LOUISE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5101 VERNON AVENUE SOUTH
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436
Mailing Address - Country:US
Mailing Address - Phone:952-920-9579
Mailing Address - Fax:
Practice Address - Street 1:5101 VERNON AVENUE SOUTH
Practice Address - Street 2:SUITE 1 B
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436
Practice Address - Country:US
Practice Address - Phone:952-920-9579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND130111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice