MEDICARE: DR. ALYSON DEAN EMERY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	33755	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B33755-01	OTHER	CA	DENTICAL

General Provider Information

NPI Number	:	1669495180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSON DEAN EMERY DDS

Provider Business Mailing Address
First Line	:	3840 WOODRUFF AVE STE 208
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2149
Country	:	US
Telephone Number	:	562-421-9361
Fax Number	:	562-421-5821

Provider Business Practice Location Address
First Line	:	3840 WOODRUFF AVE STE 208
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2149
Country	:	US
Telephone Number	:	562-421-9361
Fax Number	:	562-421-5821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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