Provider Demographics
NPI:1073646311
Name:STILLWATER ENDODONTICS DARRELL W. DAUGHERTY, DDS,PC
Entity Type:Organization
Organization Name:STILLWATER ENDODONTICS DARRELL W. DAUGHERTY, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-377-4848
Mailing Address - Street 1:1601 S SANGRE RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1847
Mailing Address - Country:US
Mailing Address - Phone:405-377-4848
Mailing Address - Fax:405-377-4859
Practice Address - Street 1:1601 S SANGRE RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1847
Practice Address - Country:US
Practice Address - Phone:405-377-4848
Practice Address - Fax:405-377-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty