Provider Demographics
NPI:1871769604
Name:HUGHESCOLONDENTISTRYPC
Entity type:Organization
Organization Name:HUGHESCOLONDENTISTRYPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANIGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIXTO
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:TIGRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-942-1945
Mailing Address - Street 1:581 ACADEMY ST OFC C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5102
Mailing Address - Country:US
Mailing Address - Phone:212-942-1945
Mailing Address - Fax:212-942-2498
Practice Address - Street 1:581 ACADEMY ST SUITE C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5102
Practice Address - Country:US
Practice Address - Phone:212-942-1945
Practice Address - Fax:212-942-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0432621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01278335Medicaid
NY1467517979Medicaid