Healthcare Provider Details

I. General information

NPI: 1669228169
Provider Name (Legal Business Name): MATTHEW ERIC KNUDSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 LUDINGTON ST
ESCANABA MI
49829-2739
US

IV. Provider business mailing address

1830 LUDINGTON ST
ESCANABA MI
49829-2739
US

V. Phone/Fax

Practice location:
  • Phone: 906-789-3936
  • Fax: 906-786-3936
Mailing address:
  • Phone: 906-786-3936
  • Fax: 906-786-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901602871
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: