Healthcare Provider Details

I. General information

NPI: 1518998194
Provider Name (Legal Business Name): PRESTON R KNIGHT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W. MILL STREET
BAYFIELD CO
81122
US

IV. Provider business mailing address

30 W. MILL STREET
BAYFIELD CO
81122
US

V. Phone/Fax

Practice location:
  • Phone: 970-884-9306
  • Fax: 970-884-9375
Mailing address:
  • Phone: 970-884-9306
  • Fax: 970-884-9375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8993
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: