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General NPI Number Information
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NPI Number | 1205831096
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Entity Type | Individual
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Provider Name | RICHARD LEE EMANUEL D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5686 TELEGRAPH RD
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City | SAINT LOUIS
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State | MO
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Zip | 63129-4243
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Country | US
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Telephone | 314-846-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 6810 CHINA LAKE DR
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City | SAINT LOUIS
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State | MO
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Zip | 63129-5453
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Country | US
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Telephone | 314-846-0664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12983
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License Number State | MO
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