Provider Demographics
NPI:1811264005
Name:EMMA ETEMADI, DDS, PS
Entity type:Organization
Organization Name:EMMA ETEMADI, DDS, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:ETEMADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-802-5806
Mailing Address - Street 1:14142 MAIN ST NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-9007
Mailing Address - Country:US
Mailing Address - Phone:425-802-5806
Mailing Address - Fax:
Practice Address - Street 1:14142 MAIN ST NE
Practice Address - Street 2:SUITE 104
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-9007
Practice Address - Country:US
Practice Address - Phone:425-802-5806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010166261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental