MEDICARE: DR. RICHARD LEE EMANUEL D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12983	MO

General Provider Information

NPI Number	:	1205831096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LEE EMANUEL D.M.D.

Provider Business Mailing Address
First Line	:	6810 CHINA LAKE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-5453
Country	:	US
Telephone Number	:	314-846-0664
Fax Number	:

Provider Business Practice Location Address
First Line	:	5686 TELEGRAPH RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-4243
Country	:	US
Telephone Number	:	314-846-0101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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