Healthcare Provider Details

I. General information

NPI: 1851701924
Provider Name (Legal Business Name): ROBERT NELSON EMORY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 OLDE TOWNE RD
WILLIAMSBURG VA
23188-8111
US

IV. Provider business mailing address

5249 OLDE TOWNE RD
WILLIAMSBURG VA
23188-8111
US

V. Phone/Fax

Practice location:
  • Phone: 757-259-3258
  • Fax: 757-220-1953
Mailing address:
  • Phone: 757-259-3258
  • Fax: 757-220-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number0401003100
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: