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General NPI Number Information
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NPI Number | 1649587064
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Entity Type | Individual
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Provider Name | CLEYDES YSABEL DOUGHERTY DDS
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Gender | Female
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 5481 N UNIVERSITY DRIVE 103
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-7456
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Country | US
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Telephone | 954-575-0880
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Fax | 954-575-0890
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Provider Business Mailing Address
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Address Line | 844 FALLING WATER RD
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City | WESTON
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State | FL
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Zip | 33326
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Country | US
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Telephone | 321-961-6102
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Fax | 954-575-0890
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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 | DN 19155
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License Number State | FL
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