Provider Demographics
NPI:1831600113
Name:DAUGHERTY, WARREN PATRICK (DMD)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:PATRICK
Last Name:DAUGHERTY
Suffix:
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 1:710 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6901
Mailing Address - Country:US
Mailing Address - Phone:717-274-2913
Mailing Address - Fax:717-274-0728
Practice Address - Street 1:710 S 12TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6901
Practice Address - Country:US
Practice Address - Phone:717-274-2913
Practice Address - Fax:717-274-0728
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0350961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics