MEDICARE: ERIN JEANNE DOUGHERTY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN19885	FL

General Provider Information

NPI Number	:	1043565807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN JEANNE DOUGHERTY DMD

Provider Business Mailing Address
First Line	:	14100 58TH ST N
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33760-9900
Country	:	US
Telephone Number	:	727-824-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1344 22ND ST S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33712-2744
Country	:	US
Telephone Number	:	727-824-8181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	11/25/2025

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