Individual provider Active NPI

Erin Jeanne Dougherty, DMD

  • Dentist
  • St Petersburg, FL
National Provider Identifier
1043565807
Registry record updated Nov 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN19885 Issued in FL
Practice address
1344 22ND St S
Saint Petersburg, FL 33712-2744
Phone
(727) 824-8181
NPI assigned
Jul 18, 2012
Last updated
Nov 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN19885 FL Primary

Addresses

Primary practice location

1344 22ND St S
Saint Petersburg, FL 33712-2744

Mailing address

14100 58TH St N
Clearwater, FL 33760-9900
Phone (727) 824-8181

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251202002444 FL Practitioner - Dentist 8921591678 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
Midwestern University College of Dental Medicine, Glendale, 2012
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

14100 58TH St N
Clearwater, FL 33760-9900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN19885FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Centers of Pinellas Inc. CurrentSince Nov 25, 2025 Accepting new patients
Community Health Center of Pinellas Inc Current Accepting new patients
Community Health Centers of Pinellas Inc. CurrentSince Nov 25, 2025 Accepting new patients

Locations

14100 58th St N
Clearwater, FL 33760

14100 58th St N
Ste 100
Clearwater, FL 33760
Phone (727) 286-6224

702 Jasmine Way
Clearwater, FL 33756
Phone (832) 302-2756

12420 130th Ave N
Largo, FL 33774
Phone (727) 587-7729

1344 22nd St S
St Petersburg, FL 33712
Phone (727) 821-6701

4950 34th St N
St Petersburg, FL 33714

721 E Lime St
Tarpon Springs, FL 34689

Networks

  • Freedom Health HMO Network

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764028800000",
    "number": "1043565807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14100 58TH ST N",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337609900",
            "telephone_number": "727-824-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1344 22ND ST S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337122744",
            "telephone_number": "727-824-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "ERIN",
        "middle_name": "JEANNE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-18",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN19885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.