Provider Demographics
NPI:1760009302
Name:EMER, KYLE JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JOHN
Last Name:EMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 COBBLEMILL WAY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-5200
Mailing Address - Country:US
Mailing Address - Phone:770-851-3190
Mailing Address - Fax:
Practice Address - Street 1:6110 PINE MOUNTAIN RD NW STE 101
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3335
Practice Address - Country:US
Practice Address - Phone:770-426-0503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0160931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice