MEDICARE: DR. LUCY KNIPPENBERG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12012140A	IN

General Provider Information

NPI Number	:	1194121145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCY KNIPPENBERG DDS

Provider Business Mailing Address
First Line	:	575 RILEY HOSPITAL DR STE 4205
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5272
Country	:	US
Telephone Number	:	309-201-7062
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 RILEY HOSPITAL DR STE 4205
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5272
Country	:	US
Telephone Number	:	309-201-7062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	09/07/2022

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