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Individual

MR. JOHN EUGENE DOUGHERTY

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
1809 NW DAVIS ST, PORTLAND, OR 97209-2121
(503) 221-1973
Mailing address
1809 NW DAVIS ST, PORTLAND, OR 97209-2121
(503) 221-1973

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4716
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0000NGPJ
OR
Enumeration date
01/18/2006
Last updated
07/09/2007
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