Provider Demographics
NPI:1871650986
Name:EMERSON, RICHARD L (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:EMERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9215 SR 64 P.O. BOX 105
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-8833
Mailing Address - Country:US
Mailing Address - Phone:812-951-3776
Mailing Address - Fax:
Practice Address - Street 1:9215 SR 64
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-8833
Practice Address - Country:US
Practice Address - Phone:812-951-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120090121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice