Provider Demographics
NPI:1528659331
Name:KRAMER, EMILY AMBER (DH)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:AMBER
Last Name:KRAMER
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:AMBER
Other - Last Name:PICKLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DH
Mailing Address - Street 1:1416 DOGWOOD ST APT 4
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-1391
Mailing Address - Country:US
Mailing Address - Phone:863-398-4139
Mailing Address - Fax:
Practice Address - Street 1:570 RIVERSTONE WAY STE 1
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2940
Practice Address - Country:US
Practice Address - Phone:907-455-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK163900124Q00000X
FLDH23986124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist