Individual
MICHAEL T MCHUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1246 YELLOWSTONE AVE, STE D3, POCATELLO, ID 83201-4374
(208) 238-0125
(208) 478-2200
Mailing address
1246 YELLOWSTONE AVE, STE D3, POCATELLO, ID 83201-4374
(208) 238-0125
(208) 478-2200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1755
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010009646
BLUE SHIELD OF IDAHO
ID
01
—
612058100
US DEPARTMENT OF LABOR
—
01
—
6P591
BLUE CROSS OF IDAHO
ID
01
—
9201894
IDAHO SMILES/DENTAQUEST
ID
Enumeration date
09/15/2010
Last updated
09/15/2010
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