Provider Demographics
NPI:1295266229
Name:FLUCK, EMILY JOHNSON (DMD (GRAD: MAY 2017))
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JOHNSON
Last Name:FLUCK
Suffix:
Gender:F
Credentials:DMD (GRAD: MAY 2017)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 PEARL DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-3351
Mailing Address - Country:US
Mailing Address - Phone:215-888-4250
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:BUILDING #1, SUITE 3NE1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-3180
Practice Address - Fax:718-918-6147
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program