Individual
DR. MARK ROBERT DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
26 SURFSIDE RD, PRYOR, OK 74361-3306
(918) 344-2780
Mailing address
26 SURFSIDE RD, PRYOR, OK 74361-3306
(918) 344-2780
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5274
OK
Other
Enumeration date
09/22/2006
Last updated
07/31/2019
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