Individual
EMMANUEL UTAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 COUNTRY CLUB RD, LUMBERTON, NC 28360-0428
(910) 737-6457
(910) 739-7673
Mailing address
2200 N PERKINS RD, STILLWATER, OK 74075-3076
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8009
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/01/2023
Last updated
05/07/2025
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