Provider Demographics
NPI:1326539362
Name:MEYER, EMMA MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:MARIE
Last Name:MEYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:LICHTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9901 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2345
Mailing Address - Country:US
Mailing Address - Phone:260-489-0001
Mailing Address - Fax:
Practice Address - Street 1:9901 AUBURN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2345
Practice Address - Country:US
Practice Address - Phone:260-489-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013190A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery