Provider Demographics
NPI:1366595902
Name:HUGSTED, KARI ELISABETH (DDS)
Entity type:Individual
Prefix:MISS
First Name:KARI
Middle Name:ELISABETH
Last Name:HUGSTED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3413
Mailing Address - Country:US
Mailing Address - Phone:650-359-1066
Mailing Address - Fax:
Practice Address - Street 1:80 EUREKA SQ
Practice Address - Street 2:SUITE 216
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2654
Practice Address - Country:US
Practice Address - Phone:650-359-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB35124 01Medicaid