Provider Demographics
NPI:1548991987
Name:DALLUGE, EMILY ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ANNE
Last Name:DALLUGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 LORALIN DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4812
Mailing Address - Country:US
Mailing Address - Phone:319-239-5948
Mailing Address - Fax:
Practice Address - Street 1:508 HIGHWAY 218 N
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651-1009
Practice Address - Country:US
Practice Address - Phone:319-342-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-099871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice