Individual
DR. MICHAEL REARDON DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6930
Mailing address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(314) 251-6930
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2014016792
MO
Other
Enumeration date
06/12/2014
Last updated
06/12/2014
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