Provider Demographics
NPI:1285858985
Name:EMERSON, CLINTON WADE (DMD)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:WADE
Last Name:EMERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W MISSION ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2599
Mailing Address - Country:US
Mailing Address - Phone:918-459-0092
Mailing Address - Fax:918-455-0270
Practice Address - Street 1:800 W MISSION ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2599
Practice Address - Country:US
Practice Address - Phone:918-459-0092
Practice Address - Fax:918-455-0270
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSPECIALTY 1531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics