=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114018314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID J EMMERICH DDS MDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5800 BERKMAN DRIVE
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-452-1111
-----------------------------------------------------
Fax | 512-452-3813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5800 BERKMAN DRIVE
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-452-1111
-----------------------------------------------------
Fax | 512-452-3813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST
-----------------------------------------------------
Name | DR. DAVID J EMMERICH
-----------------------------------------------------
Credential | DDS MDS
-----------------------------------------------------
Telephone | 512-452-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 8888
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------