Healthcare Provider Details

I. General information

NPI: 1467012716
Provider Name (Legal Business Name): EMILY FUNK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WINDGATE DR STE A6
CHESTER SPRINGS PA
19425-3643
US

IV. Provider business mailing address

240 WINDGATE DR STE A6
CHESTER SPRINGS PA
19425-3643
US

V. Phone/Fax

Practice location:
  • Phone: 484-359-4615
  • Fax:
Mailing address:
  • Phone: 484-359-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS043005
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: