Healthcare Provider Details

I. General information

NPI: 1366573123
Provider Name (Legal Business Name): BEN D EMERSON JR. D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 7TH TER SUITE # 301
VERO BEACH FL
32960-7324
US

IV. Provider business mailing address

3730 7TH TER SUITE # 301
VERO BEACH FL
32960-7324
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-9700
  • Fax: 772-569-9704
Mailing address:
  • Phone: 772-569-9700
  • Fax: 772-569-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0003923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: