Provider Demographics
NPI:1396486841
Name:ANDERSON, EMARSHARAE (DMD)
Entity type:Individual
Prefix:
First Name:EMARSHARAE
Middle Name:
Last Name:ANDERSON
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 1:150 E FAYETTE ST APT 903
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1722
Mailing Address - Country:US
Mailing Address - Phone:503-888-7740
Mailing Address - Fax:
Practice Address - Street 1:200 E 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2662
Practice Address - Country:US
Practice Address - Phone:315-342-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist