Provider Demographics
NPI:1881981454
Name:HUGHES, SHANA G (DMD)
Entity type:Individual
Prefix:DR
First Name:SHANA
Middle Name:G
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:P.O. BOX 569
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4628
Mailing Address - Country:US
Mailing Address - Phone:270-866-4101
Mailing Address - Fax:270-866-4133
Practice Address - Street 1:24 CADEN WAY STE. 3
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-0569
Practice Address - Country:US
Practice Address - Phone:270-866-4101
Practice Address - Fax:270-866-4133
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY92577DMMedicaid