Provider Demographics
NPI:1194818872
Name:DOHERTY, MARK E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 PURCHASE ST.
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740
Mailing Address - Country:US
Mailing Address - Phone:508-997-1766
Mailing Address - Fax:508-996-4558
Practice Address - Street 1:1155 PURCHASE ST.
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-997-1766
Practice Address - Fax:508-996-4558
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209471223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics