Provider Demographics
NPI:1780170670
Name:DODGE, EMMA CLAIRE (DDS)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:CLAIRE
Last Name:DODGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:CLAIRE
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:40 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-1845
Mailing Address - Country:US
Mailing Address - Phone:920-838-4078
Mailing Address - Fax:
Practice Address - Street 1:1647 ADMIRAL TAUSSIG BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2803
Practice Address - Country:US
Practice Address - Phone:757-953-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist