Individual
DANIEL THOMAS DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
621 S NEW BALLAS RD # 10, SAINT LOUIS, MO 63141-8232
(314) 251-5775
(314) 251-5776
Mailing address
621 S NEW BALLAS RD # 10, SAINT LOUIS, MO 63141-8232
(314) 251-5775
(314) 251-5776
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2018019124
MO
Other
Enumeration date
06/13/2018
Last updated
06/13/2018
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