Healthcare Provider Details

I. General information

NPI: 1578329652
Provider Name (Legal Business Name): EMILY ADELMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 07/16/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 SOUTH 14TH ST
JOINT BASE LEWIS-MCCHORD WA
98433
US

IV. Provider business mailing address

3913 S ANGELINE ST
SEATTLE WA
98118-1713
US

V. Phone/Fax

Practice location:
  • Phone: 253-967-5271
  • Fax:
Mailing address:
  • Phone: 360-790-0796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61577761
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: