Individual provider Active NPI

Michael D Dougherty, D.D.S.

  • General Practice Dentistry
  • Aurora, CO
National Provider Identifier
1790745461
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
350 Issued in CO
Practice address
1550 S Potomac St
Suite 220
Aurora, CO 80012-5455
Phone
(303) 369-1069
Fax
(303) 369-1063
NPI assigned
Mar 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 350 CO Primary

Addresses

Primary practice location

1550 S Potomac St
Suite 220
Aurora, CO 80012-5455

Mailing address

1550 S Potomac St
Suite 220
Aurora, CO 80012-5455
Phone (303) 369-1069

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20160405002582 CO Order and Referring Only - DentistPractitioner - Dentist 0244538353

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
350COMDAudiologist

NPI Registry JSON

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

{
    "created_epoch": "1143244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1790745461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 S POTOMAC ST",
            "address_2": "SUITE 220",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800125455",
            "telephone_number": "303-369-1069",
            "fax_number": "303-369-1063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 S POTOMAC ST",
            "address_2": "SUITE 220",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800125455",
            "telephone_number": "303-369-1069",
            "fax_number": "303-369-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-25",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.