Provider Demographics
NPI:1053346775
Name:DOUGHERTY, WILLIAM JOHN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:DOUGHERTY
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 1:3663 E SUNSET RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3218
Mailing Address - Country:US
Mailing Address - Phone:702-436-4300
Mailing Address - Fax:702-436-0334
Practice Address - Street 1:3663 E SUNSET RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3218
Practice Address - Country:US
Practice Address - Phone:702-436-4300
Practice Address - Fax:702-436-0334
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS7-201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics