Provider Demographics
NPI:1053059634
Name:EMERY, AUSTIN STEPHEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:STEPHEN
Last Name:EMERY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 W 250 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4134
Mailing Address - Country:US
Mailing Address - Phone:801-837-3329
Mailing Address - Fax:
Practice Address - Street 1:2961 W MAPLE LOOP DR STE 110
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5717
Practice Address - Country:US
Practice Address - Phone:801-766-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12844723-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice