Organization
MICHAEL T MCHUGH D.D.S., PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL T MCHUGH D.D.S. (PRESIDENT)
(208) 238-0125
Entity
Organization
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
261QD0000X
Dental Clinic/Center
Primary
D1755
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010009646
BLUE SHIELD OF IDAHO
ID
01
—
123544
DESERET MUTUAL
—
01
—
679416
UNITED CONCORDIA
—
01
—
68007
BLUE CROSS OF IDAHO
ID
Enumeration date
04/10/2007
Last updated
09/07/2007
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