Provider Demographics
NPI:1407932064
Name:EMRICH, SAMUEL RIDDICK (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:RIDDICK
Last Name:EMRICH
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 GLENWOOD AVE, STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608
Mailing Address - Country:US
Mailing Address - Phone:919-821-0008
Mailing Address - Fax:919-821-0010
Practice Address - Street 1:2717 GLENWOOD AVE, STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608
Practice Address - Country:US
Practice Address - Phone:919-821-0008
Practice Address - Fax:919-821-0010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice