Provider Demographics
NPI:1265552228
Name:DAUGHERTY, BARKLEY BISHOP JR (DMD)
Entity type:Individual
Prefix:DR
First Name:BARKLEY
Middle Name:BISHOP
Last Name:DAUGHERTY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1922
Mailing Address - Country:US
Mailing Address - Phone:716-372-4722
Mailing Address - Fax:716-372-4461
Practice Address - Street 1:2210 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1922
Practice Address - Country:US
Practice Address - Phone:716-372-4722
Practice Address - Fax:716-372-4461
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0382261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice