Provider Demographics
NPI:1275862047
Name:EMERY, BENJAMIN RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RICHARD
Last Name:EMERY
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 1:1122 S CONWELL ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3965
Mailing Address - Country:US
Mailing Address - Phone:307-234-6054
Mailing Address - Fax:
Practice Address - Street 1:1122 S CONWELL ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3965
Practice Address - Country:US
Practice Address - Phone:307-234-6054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY12391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice