Provider Demographics
NPI:1518919497
Name:EMANUEL, DAVID JOHN (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:EMANUEL
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 1:1033 W COLLEGE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5290
Mailing Address - Country:US
Mailing Address - Phone:920-739-4246
Mailing Address - Fax:920-739-4567
Practice Address - Street 1:1033 W COLLEGE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5290
Practice Address - Country:US
Practice Address - Phone:920-739-4246
Practice Address - Fax:920-739-4567
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist