Provider Demographics
NPI:1194923078
Name:EMERSON, CRAIG B (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:B
Last Name:EMERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:COVELO
Mailing Address - State:CA
Mailing Address - Zip Code:95428
Mailing Address - Country:US
Mailing Address - Phone:707-983-6404
Mailing Address - Fax:707-983-6051
Practice Address - Street 1:HIGHWAY 162 AND BIGGAR LANE
Practice Address - Street 2:
Practice Address - City:COVELO
Practice Address - State:CA
Practice Address - Zip Code:95428
Practice Address - Country:US
Practice Address - Phone:707-983-6404
Practice Address - Fax:707-983-6051
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist