MEDICARE: BRIAN KNAPP 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	28223	FL

General Provider Information

NPI Number	:	1215711478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN KNAPP DDS

Provider Business Mailing Address
First Line	:	3239 GRANT CREEK TRL
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3588
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2808 REMINGTON GREEN CIR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-8706
Country	:	US
Telephone Number	:	410-242-2580
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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