Provider Demographics
NPI:1699777920
Name:DOHERTY, CAROLYN J (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:J
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:23451 MADISON ST
Mailing Address - Street 2:STE 260
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4761
Mailing Address - Country:US
Mailing Address - Phone:310-373-7743
Mailing Address - Fax:310-373-7744
Practice Address - Street 1:23451 MADISON ST
Practice Address - Street 2:STE 260
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4761
Practice Address - Country:US
Practice Address - Phone:310-373-7743
Practice Address - Fax:310-373-7744
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA356531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice