Provider Demographics
NPI:1669632808
Name:FERRAZ-DOUGHERTY, ANA PAULA (DMD)
Entity Type:Individual
Prefix:
First Name:ANA PAULA
Middle Name:
Last Name:FERRAZ-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 1:6826 N LOOP 1604 E
Mailing Address - Street 2:#102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5328
Mailing Address - Country:US
Mailing Address - Phone:210-656-5200
Mailing Address - Fax:
Practice Address - Street 1:6826 N LOOP 1604 E
Practice Address - Street 2:#102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5328
Practice Address - Country:US
Practice Address - Phone:210-656-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN183241223G0001X
TXTX25171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice