Provider Demographics
NPI:1275604548
Name:EMRICH, R MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:MICHAEL
Last Name:EMRICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-2626
Mailing Address - Country:US
Mailing Address - Phone:419-468-1100
Mailing Address - Fax:614-319-4212
Practice Address - Street 1:112 S MARKET ST
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-2626
Practice Address - Country:US
Practice Address - Phone:419-468-1100
Practice Address - Fax:614-319-4212
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0180571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice