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General NPI Number Information
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NPI Number | 1093981466
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Entity Type | Organization
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Legal Business Name | ROBERT J DOHERTY DDS PC
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 280 MAMARONECK AVE SUITE #210
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City | WHITE PLAINS
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State | NY
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Zip | 10605-1438
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Country | US
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Telephone | 914-948-3883
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Fax |
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Provider Business Mailing Address
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Address Line | 280 MAMARONECK AVE SUITE #210
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City | WHITE PLAINS
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State | NY
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Zip | 10605-1438
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Country | US
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Telephone | 914-948-3883
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT J DOHERTY
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Credential | DDS
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Telephone | 914-948-3883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 028025
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License Number State | NY
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