Provider Demographics
NPI:1346300563
Name:EMMANUELE, ROLAND C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:C
Last Name:EMMANUELE
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 1:4 HINCHCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8810
Mailing Address - Country:US
Mailing Address - Phone:845-564-4762
Mailing Address - Fax:
Practice Address - Street 1:4 HINCHCLIFFE DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8810
Practice Address - Country:US
Practice Address - Phone:845-564-4762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0272751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice