Healthcare Provider Details

I. General information

NPI: 1669588208
Provider Name (Legal Business Name): CARMELLA M. KNOERNSCHILD, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 W PARKWAY DR
RUSSELLVILLE AR
72802-2108
US

IV. Provider business mailing address

2015 W PARKWAY DR
RUSSELLVILLE AR
72802-2108
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-2138
  • Fax: 479-890-6796
Mailing address:
  • Phone: 479-968-2138
  • Fax: 479-890-6796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2878
License Number StateAR

VIII. Authorized Official

Name: DR. CARMELLA KNOERNSCHILD
Title or Position: ORTHODONTIST/OFFICER
Credential: DDS
Phone: 479-968-2138