Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | AZ3022 | AZ |
NPI | 1275800880 |
---|---|
Provider Name | Dr. Mark Edward Emshwiller |
First Address | Prescott Valley, AZ 86314 |
Second Address | Prescott Valley, AZ 86314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2011 |
Last Update Date | 28/11/2011 |