Individual
DR. JOHN LEWIS DAUGHERTY IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6490 E MAIN ST STE D, REYNOLDSBURG, OH 43068-2394
(614) 866-3301
Mailing address
6490 E MAIN ST STE D, REYNOLDSBURG, OH 43068-2394
(614) 866-3301
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-022121
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2701339
—
OH
Enumeration date
12/04/2006
Last updated
07/09/2023
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