Individual
JOHN DENNIS DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
27 N MOUNTAIN BLVD, MOUNTAINTOP, PA 18707-1116
(570) 474-5923
(570) 403-5484
Mailing address
27 N MOUNTAIN BLVD, MOUNTAINTOP, PA 18707-1116
(570) 474-5923
(570) 403-5484
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
18129
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510561
UNITED CONCORDIA
—
Enumeration date
08/08/2006
Last updated
07/08/2007
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