MEDICARE: DR. JEFFREY CHRISTOPHER KNUDSON D.D.S

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	1223G0001X	General Practice Dentistry	DE60170676	WA

General Provider Information

NPI Number	:	1316250608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY CHRISTOPHER KNUDSON D.D.S

Provider Business Mailing Address
First Line	:	909 NE 45TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4714
Country	:	US
Telephone Number	:	206-523-7180
Fax Number	:	206-523-0323

Provider Business Practice Location Address
First Line	:	8511 GREENWOOD AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-3613
Country	:	US
Telephone Number	:	206-782-8223
Fax Number	:

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

Provider Enumeration Date	:	07/15/2010
Last Update Date	:	03/16/2016

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