Healthcare Provider Details

I. General information

NPI: 1427132117
Provider Name (Legal Business Name): MILLHOPPER FAMILY DENTISTRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 NW 43RD STREET
GAINESVILLE FL
32606-6104
US

IV. Provider business mailing address

3510 NW 43RD STREET
GAINESVILLE FL
32606-6104
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-1705
  • Fax: 352-377-1093
Mailing address:
  • Phone: 352-377-1705
  • Fax: 352-377-1093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN18867
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19319
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN008805
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17110
License Number StateFL

VIII. Authorized Official

Name: DR. KENNETH WILLIAM KNOPF
Title or Position: OWNER PRESIDENT
Credential: DMD
Phone: 352-377-1705