Provider Demographics
NPI:1831414275
Name:EMMERT, JUDITH A (DMD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:A
Last Name:EMMERT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 POTOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-3838
Mailing Address - Country:US
Mailing Address - Phone:301-797-3322
Mailing Address - Fax:
Practice Address - Street 1:638 POTOMAC AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-3838
Practice Address - Country:US
Practice Address - Phone:301-797-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11461OtherDENTAL LICENSE
MDD37373OtherCDS
MDD37373OtherCDS