Provider Demographics
NPI:1912072794
Name:GADDIS, HUGHES DONAVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUGHES
Middle Name:DONAVAN
Last Name:GADDIS
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 1:1605 WEST COURT STREET
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483
Mailing Address - Country:US
Mailing Address - Phone:318-628-2781
Mailing Address - Fax:318-648-7040
Practice Address - Street 1:1605 W COURT ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-2653
Practice Address - Country:US
Practice Address - Phone:318-628-2781
Practice Address - Fax:318-648-7040
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA29151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice