Individual provider Active NPI

Emily H Nieto, DMD, MPH

  • Dentist
  • Flagstaff, AZ
National Provider Identifier
1033527155
Registry record updated Apr 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D011710 Issued in AZ
Practice address
2920 N 4TH St
Flagstaff, AZ 86004-1816
Phone
(928) 522-9405
Fax
(928) 522-9537
NPI assigned
Aug 1, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D011710 AZ Primary
General Practice Dentistry 1223G0001X DD4122 NM

Addresses

Primary practice location

2920 N 4TH St
Flagstaff, AZ 86004-1816

Mailing address

PO Box 1231
Tucson, AZ 85702-1231
Phone (520) 670-3909

Other practice location 1

1024 N San Francisco St Ste 101
Flagstaff, AZ 86001-3266
Phone (928) 779-0395

Other names 1

  • Emily Harry Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AZ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171129000722 TX Practitioner - Oral Surgery 0840560314 Reassigns benefits to 1 organization
I20230512001809 AZ Practitioner - Dentist 0840560314 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D011710AZMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince Oct 15, 2017 Accepting new patients
North Country Healthcare, Inc. Current Accepting new patients
North Country Healthcare, Inc. CurrentSince May 8, 2023 Accepting new patients
North Country Healthcare, Inc. CurrentSince May 8, 2023 Accepting new patients
North Country Healthcare, Inc. Past Accepting new patients

Locations

2920 N 4th St
Flagstaff, AZ 86004
Phone (928) 213-6100

2650 E Show Low Lake Rd
Ste 1
Show Low, AZ 85901
Phone (928) 537-4300

620 Lee St
Winslow, AZ 86047
Phone (928) 288-8700

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1033527155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1231",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857021231",
            "telephone_number": "520-670-3909",
            "fax_number": "520-309-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 N 4TH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041816",
            "telephone_number": "928-522-9405",
            "fax_number": "928-522-9537"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1024 N San Francisco St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860013266",
            "country_code": "US",
            "telephone_number": "928-779-0395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIETO",
        "first_name": "EMILY",
        "middle_name": "H",
        "credential": "DMD, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-01",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D011710",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD4122",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "HARRY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.