MEDICARE: DR. KERRY ROBERT KNAPE 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	12007875A	IN

General Provider Information

NPI Number	:	1649441890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY ROBERT KNAPE DDS

Provider Business Mailing Address
First Line	:	100 S MAIN STREET
Second Line	:	PO BOX 521
City	:	NORTH LIBERTY
State	:	IN
Zip	:	46554
Country	:	US
Telephone Number	:	574-656-8175
Fax Number	:	574-656-8137

Provider Business Practice Location Address
First Line	:	100 S MAIN STREET
Second Line	:
City	:	NORTH LIBERTY
State	:	IN
Zip	:	46554
Country	:	US
Telephone Number	:	574-656-8175
Fax Number	:	574-656-8137

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

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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