Provider Demographics
NPI:1639912470
Name:EISENBERGER, EMILY ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ANN
Last Name:EISENBERGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 RIVERS EDGE PKWY APT 305
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-5203
Mailing Address - Country:US
Mailing Address - Phone:630-877-0451
Mailing Address - Fax:
Practice Address - Street 1:10 HASSAN ST NE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1800
Practice Address - Country:US
Practice Address - Phone:320-587-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist