Provider Demographics
NPI:1649587064
Name:DOUGHERTY, CLEYDES YSABEL (DDS)
Entity Type:Individual
Prefix:
First Name:CLEYDES
Middle Name:YSABEL
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 FALLING WATER RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:321-961-6102
Mailing Address - Fax:954-575-0890
Practice Address - Street 1:5481 N UNIVERSITY DRIVE
Practice Address - Street 2:103
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-7456
Practice Address - Country:US
Practice Address - Phone:954-575-0880
Practice Address - Fax:954-575-0890
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 191551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice