Provider Demographics
NPI:1346308061
Name:DOUGHERTY, CARRIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
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 1:3055 ROSLYN ST STE 260
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3323
Mailing Address - Country:US
Mailing Address - Phone:303-399-1488
Mailing Address - Fax:303-399-3285
Practice Address - Street 1:3055 ROSLYN ST STE 260
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3323
Practice Address - Country:US
Practice Address - Phone:303-399-1488
Practice Address - Fax:303-399-3285
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist