Active NPI
Cielo Constanza Doherty, DDS
- Pediatric Dentistry
- Shiprock, NM
National Provider Identifier
1164410882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 6891
- Practice address
- US Hwy 491 North
Shiprock, NM 87420 - Phone
- (505) 368-6401
- Fax
- (505) 368-6431
- NPI assigned
- Oct 6, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 6891 | CO | Primary |
Addresses
Primary practice location
US Hwy 491 North
Shiprock, NM 87420
Mailing address
PO Box 160
Shiprock, NM 87420-0160
Phone (505) 368-6401
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52686264 | Medicaid | CO | |
| B4089 | Medicaid | NM | |
| 618423 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6891 | CO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190073600000",
"number": "1164410882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 160",
"city": "SHIPROCK",
"state": "NM",
"postal_code": "874200160",
"telephone_number": "505-368-6401",
"fax_number": "505-368-6431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "US HWY 491 NORTH",
"city": "SHIPROCK",
"state": "NM",
"postal_code": "87420",
"telephone_number": "505-368-6401",
"fax_number": "505-368-6431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOHERTY",
"first_name": "CIELO",
"middle_name": "CONSTANZA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-06",
"last_updated": "2007-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CO",
"license": "6891",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "52686264",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "B4089",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "618423",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shiprock, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.