Provider Demographics
NPI:1174816367
Name:DOUGHERTY, MARTHA ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ANN
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TANKARD LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1159
Mailing Address - Country:US
Mailing Address - Phone:973-713-3933
Mailing Address - Fax:
Practice Address - Street 1:276 HIGHWAY 202/31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1759
Practice Address - Country:US
Practice Address - Phone:908-237-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024720001223G0001X
PADS0386331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice