Provider Demographics
NPI:1780697110
Name:HUGHES, THOMAS JUDE (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JUDE
Last Name:HUGHES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53806-0600
Mailing Address - Country:US
Mailing Address - Phone:608-725-2361
Mailing Address - Fax:608-725-5295
Practice Address - Street 1:201 W AMELIA ST
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53806-0600
Practice Address - Country:US
Practice Address - Phone:608-725-2361
Practice Address - Fax:608-725-5295
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33411600Medicaid