MEDICARE: S&R KNITER DENTAL CORPORATION

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	261QD0000X	Dental Clinic/Center	37123	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B37123-01	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1720273360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S&R KNITER DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	8205 SANTA MONICA BLVD STE 12
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5963
Country	:	US
Telephone Number	:	323-654-1100
Fax Number	:	323-654-2043

Provider Business Practice Location Address
First Line	:	8205 SANTA MONICA BLVD STE 12
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5963
Country	:	US
Telephone Number	:	323-654-1100
Fax Number	:	323-654-2043

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SINAIDA KNITER
Credential	:	DDS
Telephone Number	:	323-654-1100

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	08/14/2019

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