Provider Demographics
NPI:1477677078
Name:DAUGHERTY, DAVID SHOFF (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SHOFF
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9688 ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:NY
Mailing Address - Zip Code:14744-8710
Mailing Address - Country:US
Mailing Address - Phone:585-567-2241
Mailing Address - Fax:585-567-2297
Practice Address - Street 1:9660 RT #19
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:NY
Practice Address - Zip Code:14744-0037
Practice Address - Country:US
Practice Address - Phone:585-567-2241
Practice Address - Fax:585-567-2297
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-05-06
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-05-06
Provider Licenses
StateLicense IDTaxonomies
NY0467381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice