Provider Demographics
NPI:1245725431
Name:EMERY, ANDREW R (DMD, MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:EMERY
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COMMUNITY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8088
Mailing Address - Country:US
Mailing Address - Phone:207-622-5814
Mailing Address - Fax:
Practice Address - Street 1:5 COMMUNITY DR STE 1
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8088
Practice Address - Country:US
Practice Address - Phone:207-622-5814
Practice Address - Fax:207-621-4360
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN50531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery