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| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | DAUGHERTY, DWIGHT R | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| Description | License number: 014206 | [sources] | |||
| NPI | 1598891012 | [sources] | |||
| Sector | 40-DENTIST | [sources] | |||
| Status | not available | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from Missouri's Medicaid program.
United States of America · MMAC
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