Doctor Name: | DR. CIELO CONSTANZA DOHERTY |
NPI Number: | 1164410882 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DDS |
License Number: | 6891 |
Business Practice Address: | Us Hwy 491 North Shiprock, NM - 87420 |
Business Phone Number: | 5053686401 |
Business Fax Number: | 5053686431 |
Mailing Address: | Po Box 160, SHIPROCK |
State: | NM |
Postal Code: | 874200160 |
Phone Number: | 5053686401 |
Fax Number: | 5053686431 |
NPI Enumeration Date: | 10/06/2005 |
NPI Last Update Date: | 09/18/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 6891 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |