Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | S7-20 | NV |
NPI | 1053346775 |
---|---|
Provider Name | Dr. William John Dougherty JR. |
First Address | Las Vegas, NV 89120-3218 |
Second Address | Las Vegas, NV 89120-3218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |