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NPI Code Detail

MEDICARE: ROBIN D KNODEL D.D.S.

MEDICARE: ROBIN D KNODEL 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
11223G0001XGeneral Practice Dentistry4519WI

General Provider Information

NPI Number : 1417070665
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBIN D KNODEL D.D.S.
Provider Business Mailing Address
First Line : 4060 N MAIN ST
Second Line : SUITE 102
City : RACINE
State : WI
Zip : 53402-3121
Country : US
Telephone Number : 262-639-7298
Fax Number :
Provider Business Practice Location Address
First Line : 4060 N MAIN ST
Second Line : SUITE 102
City : RACINE
State : WI
Zip : 53402-3121
Country : US
Telephone Number : 262-639-7298
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 07/08/2007

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