Provider Demographics
NPI:1093981466
Name:ROBERT J DOHERTY DDS PC
Entity Type:Organization
Organization Name:ROBERT J DOHERTY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-948-3883
Mailing Address - Street 1:280 MAMARONECK AVE
Mailing Address - Street 2:SUITE #210
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1438
Mailing Address - Country:US
Mailing Address - Phone:914-948-3883
Mailing Address - Fax:
Practice Address - Street 1:280 MAMARONECK AVE
Practice Address - Street 2:SUITE #210
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1438
Practice Address - Country:US
Practice Address - Phone:914-948-3883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028025261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery