Healthcare Provider Details

I. General information

NPI: 1245403286
Provider Name (Legal Business Name): THOMAS P DOUGHERTY ORAL MAXILLOFACIAL SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5317 LIMESTONE RD
WILMINGTON DE
19808-1252
US

IV. Provider business mailing address

5317 LIMESTONE RD
WILMINGTON DE
19808-1252
US

V. Phone/Fax

Practice location:
  • Phone: 302-239-2500
  • Fax: 302-239-0552
Mailing address:
  • Phone: 302-239-2500
  • Fax: 302-239-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: THOMAS P DOUGHERTY
Title or Position: ORAL MAXILLOFACIAL SURGEON
Credential:
Phone: 302-239-2500