Jeff M Dougherty, D.M.D Valid NPI

Individual provider · General Practice Dentistry · O Fallon, MO

NPI

1598828030

Type

Individual (Type 1)

Primary specialty

General Practice Dentistry (Dentist)

Specialty group

Dental Providers

Taxonomy code

1223G0001X

License number

2004020376 (MO)

Sex

Male

Sole proprietor

Yes

Enumerated

2006-12-18

Last updated

2007-07-08