Provider Demographics
NPI:1316022700
Name:ACKERMON, EMMETT SMOAK JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:EMMETT
Middle Name:SMOAK
Last Name:ACKERMON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:EMMETT
Other - Middle Name:SMOAK
Other - Last Name:ACKERMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLLC
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525
Mailing Address - Country:US
Mailing Address - Phone:919-488-0233
Mailing Address - Fax:919-488-0234
Practice Address - Street 1:66 WHEATON AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596
Practice Address - Country:US
Practice Address - Phone:919-488-0233
Practice Address - Fax:919-488-0234
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990052Medicaid
NC5469Medicaid
NC8990052Medicaid