Provider Demographics
NPI:1760517221
Name:MARK B HUGHES DDS PC
Entity Type:Organization
Organization Name:MARK B HUGHES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-776-1113
Mailing Address - Street 1:6591 W THUNDERBIRD RD STE C1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3719
Mailing Address - Country:US
Mailing Address - Phone:623-776-1113
Mailing Address - Fax:
Practice Address - Street 1:6591 W THUNDERBIRD RD STE C1
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3719
Practice Address - Country:US
Practice Address - Phone:623-776-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1407910474OtherTYPR I NPI