Active NPI
Cleydes Ysabel Dougherty, DDS
- General Practice Dentistry
- Coral Springs, FL
National Provider Identifier
1649587064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN 19155
- Practice address
- 5481 N University Drive
103
Coral Springs, FL 33067-7456 - Phone
- (954) 575-0880
- Fax
- (954) 575-0890
- NPI assigned
- Sep 7, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN 19155 | FL | Primary |
Addresses
Primary practice location
5481 N University Drive
103
Coral Springs, FL 33067-7456
Mailing address
844 Falling Water Rd
Weston, FL 33326
Phone (321) 961-6102
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 |
|---|---|---|---|
| DN 19155 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473811200000",
"number": "1649587064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "844 FALLING WATER RD",
"city": "WESTON",
"state": "FL",
"postal_code": "33326",
"telephone_number": "321-961-6102",
"fax_number": "954-575-0890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5481 N UNIVERSITY DRIVE",
"address_2": "103",
"city": "CORAL SPRINGS",
"state": "FL",
"postal_code": "330677456",
"telephone_number": "954-575-0880",
"fax_number": "954-575-0890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "CLEYDES",
"middle_name": "YSABEL",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-07",
"last_updated": "2016-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN 19155",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coral Springs, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.