Healthcare Provider Details

I. General information

NPI: 1558496430
Provider Name (Legal Business Name): JAMES EMERSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N 5TH AVE
SEQUIM WA
98382-3079
US

IV. Provider business mailing address

550 N 5TH AVE
SEQUIM WA
98382-3079
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-4311
  • Fax: 360-681-0875
Mailing address:
  • Phone: 360-683-4311
  • Fax: 360-681-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00007036
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: