Healthcare Provider Details

I. General information

NPI: 1073646311
Provider Name (Legal Business Name): STILLWATER ENDODONTICS DARRELL W. DAUGHERTY, DDS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S SANGRE RD
STILLWATER OK
74074-1847
US

IV. Provider business mailing address

1601 S SANGRE RD
STILLWATER OK
74074-1847
US

V. Phone/Fax

Practice location:
  • Phone: 405-377-4848
  • Fax: 405-377-4859
Mailing address:
  • Phone: 405-377-4848
  • Fax: 405-377-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DARRELL W DAUGHERTY
Title or Position: OWNER
Credential: DDS
Phone: 405-377-4848