Provider Demographics
NPI:1912027814
Name:HUGHES, BERTRAM JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:JEFFREY
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 SW 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-8540
Mailing Address - Country:US
Mailing Address - Phone:352-378-3323
Mailing Address - Fax:352-378-0323
Practice Address - Street 1:316 SW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-8540
Practice Address - Country:US
Practice Address - Phone:352-378-3323
Practice Address - Fax:352-378-0323
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist