Individual
DR. CIELO CONSTANZA DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6891
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52686264
—
CO
05
—
618423
—
AZ
05
—
B4089
—
NM
Enumeration date
10/06/2005
Last updated
09/18/2007
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