MEDICARE: DR. GIL TODD KNUTSON 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	2358	WI

General Provider Information

NPI Number	:	1750382719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIL TODD KNUTSON DDS

Provider Business Mailing Address
First Line	:	17585 W NORTH AVE
Second Line	:	STE 210
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4365
Country	:	US
Telephone Number	:	262-784-4222
Fax Number	:	262-784-4472

Provider Business Practice Location Address
First Line	:	17585 W NORTH AVE
Second Line	:	STE 210
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4365
Country	:	US
Telephone Number	:	262-784-4222
Fax Number	:	262-784-4472

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/08/2007

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