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General NPI Number Information
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NPI Number | 1235227521
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Entity Type | Individual
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Provider Name | ROBERT EDWARD DOHERTY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 CONGRESS ST SUITE 3 E
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City | QUINCY
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State | MA
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Zip | 02169-0908
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Country | US
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Telephone | 617-328-0693
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Fax | 617-328-0694
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Provider Business Mailing Address
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Address Line | 33 CURVE ST
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City | SHERBORN
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State | MA
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Zip | 01770-1052
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Country | US
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Telephone | 508-653-7480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11693
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License Number State | MA
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