Provider Demographics
NPI:1720500853
Name:HUGHES, DESTANEE BROOKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DESTANEE
Middle Name:BROOKE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25876 OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6220
Mailing Address - Country:US
Mailing Address - Phone:225-931-6197
Mailing Address - Fax:
Practice Address - Street 1:1310 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4810
Practice Address - Country:US
Practice Address - Phone:225-664-7771
Practice Address - Fax:225-667-3285
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice