Provider Demographics
NPI:1962055897
Name:MARKWOOD, EMILY ALICE (DMD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ALICE
Last Name:MARKWOOD
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 1:1824 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7114
Mailing Address - Country:US
Mailing Address - Phone:309-826-2549
Mailing Address - Fax:
Practice Address - Street 1:201 W SPRINGFIELD AVE STE 505
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4843
Practice Address - Country:US
Practice Address - Phone:217-954-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032254122300000X
IL019.0322541223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health