Provider Demographics
NPI:1770284283
Name:EMERSON, DYLAN JOSEPH
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:JOSEPH
Last Name:EMERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SANDY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WARD
Mailing Address - State:AR
Mailing Address - Zip Code:72176-8005
Mailing Address - Country:US
Mailing Address - Phone:409-719-1903
Mailing Address - Fax:
Practice Address - Street 1:3680 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6203
Practice Address - Country:US
Practice Address - Phone:409-719-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR47571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice