Provider Demographics
NPI:1750726956
Name:HUDEPOHL, EMILY L (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:L
Last Name:HUDEPOHL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:L
Other - Last Name:KOZAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2488 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1216
Mailing Address - Country:US
Mailing Address - Phone:513-363-9110
Mailing Address - Fax:
Practice Address - Street 1:4723 CORNELL RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-7406
Practice Address - Country:US
Practice Address - Phone:513-489-0607
Practice Address - Fax:513-247-8942
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-024228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist