Provider Demographics
NPI:1578184347
Name:MALTBA, EMILY BROOKE WHEELER (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:BROOKE WHEELER
Last Name:MALTBA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:BROOKE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:259 IVY CIR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-3028
Mailing Address - Country:US
Mailing Address - Phone:828-443-6184
Mailing Address - Fax:
Practice Address - Street 1:835 CLAREMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2488
Practice Address - Country:US
Practice Address - Phone:336-835-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-02
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice