Provider Demographics
NPI:1508388620
Name:HEIMBROOK, EMILY W (DMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:W
Last Name:HEIMBROOK
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 1:4901 N TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-7076
Mailing Address - Country:US
Mailing Address - Phone:704-921-0204
Mailing Address - Fax:803-226-9247
Practice Address - Street 1:4901 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-7076
Practice Address - Country:US
Practice Address - Phone:704-921-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8974122300000X
NC11220122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist