Provider Demographics
NPI:1689285967
Name:DOUGHERTY, KRISTI LOUISE (RDH)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:LOUISE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:KRISTI
Other - Middle Name:LOUISE
Other - Last Name:FULTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:501 28TH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3003
Mailing Address - Country:US
Mailing Address - Phone:303-602-6333
Mailing Address - Fax:303-436-4748
Practice Address - Street 1:501 28TH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3003
Practice Address - Country:US
Practice Address - Phone:303-602-6333
Practice Address - Fax:303-436-4748
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905411124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist