Healthcare Provider Details

I. General information

NPI: 1508923418
Provider Name (Legal Business Name): TERYL K EMERY D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 LOUISIANA HIGHWAY 1
INNIS LA
70747-0889
US

IV. Provider business mailing address

PO BOX 889
INNIS LA
70747-0889
US

V. Phone/Fax

Practice location:
  • Phone: 225-492-3775
  • Fax: 225-492-3782
Mailing address:
  • Phone: 225-492-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5400
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: