Provider Demographics
NPI:1376033571
Name:STILL, EMILY ANNE (DMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:STILL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 BRIDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9003
Mailing Address - Country:US
Mailing Address - Phone:502-494-8761
Mailing Address - Fax:
Practice Address - Street 1:3684 HIGHWAY 150 STE 9
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9692
Practice Address - Country:US
Practice Address - Phone:812-923-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101416122300000X
390200000X
IN12013759A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program