Provider Demographics
NPI:1023049210
Name:HUGHES, CHRIS DIXON (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:DIXON
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 1:403 CLINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4011
Mailing Address - Country:US
Mailing Address - Phone:601-408-1817
Mailing Address - Fax:601-926-4649
Practice Address - Street 1:403 CLINTON PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4011
Practice Address - Country:US
Practice Address - Phone:601-926-4647
Practice Address - Fax:601-926-4649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOS 389 051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06271376Medicaid