Individual
JOHN MICHAEL DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8900 PENN AVE S, SUITE 202, BLOOMINGTON, MN 55431-2068
(952) 888-1861
(952) 888-1883
Mailing address
8900 PENN AVE S, SUITE 202, BLOOMINGTON, MN 55431-2068
(952) 888-1861
(952) 888-1883
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7408
MN
Other
Enumeration date
10/11/2006
Last updated
07/08/2007
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