Individual
DR. JACK Y PUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
442 GLOVER AVE, ENTERPRISE, AL 36330
(334) 347-6456
(334) 393-3817
Mailing address
PO BOX 311870, ENTERPRISE, AL 36331-1870
(334) 347-6456
(334) 393-3817
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2582 C.S.
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515-34127
BLUE CROSS BLUE SHIELD
AL
Enumeration date
03/23/2007
Last updated
07/08/2007
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