Provider Demographics
NPI:1720223498
Name:EMMONS, PETER A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:EMMONS
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 1:12391 S. 4000 W.
Mailing Address - Street 2:STE 206
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096
Mailing Address - Country:US
Mailing Address - Phone:801-849-1045
Mailing Address - Fax:801-938-9479
Practice Address - Street 1:263 COUNTRY CLUB DR.
Practice Address - Street 2:STE 103
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074
Practice Address - Country:US
Practice Address - Phone:435-882-2850
Practice Address - Fax:435-843-8832
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6319-15122300000X
TX28763122300000X
UT8938459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist