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General NPI Number Information
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NPI Number | 1861001646
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Entity Type | Individual
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Provider Name | JACK T EMORY DDS
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Gender | Male
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 01/17/2026
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Provider Practice Location Address
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Address Line | 66 SPRINGER DR STE 204
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-2307
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Country | US
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Telephone | 303-791-0472
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Fax |
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Provider Business Mailing Address
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Address Line | 4321 OLD WINDMILL WAY
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City | CASTLE ROCK
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State | CO
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Zip | 80109-8656
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Country | US
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Telephone | 314-603-3406
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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 | 00204600
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61675
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2020025847
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License Number State | MO
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