Individual
DR. MARK DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
17300 YORBA LINDA BLVD, SUITE H, YORBA LINDA, CA 92886-3810
(714) 993-1194
(714) 524-0397
Mailing address
17300 YORBA LINDA BLVD, SUITE H, YORBA LINDA, CA 92886-3810
(714) 993-1194
(714) 524-0397
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
36359
CA
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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