Healthcare Provider Details

I. General information

NPI: 1295096014
Provider Name (Legal Business Name): CORY JOSEPH KNAPE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHERRY ST SE
GRAND RAPIDS MI
49503-4526
US

IV. Provider business mailing address

3189 ABINGTON DR NW
GRAND RAPIDS MI
49544-1626
US

V. Phone/Fax

Practice location:
  • Phone: 616-776-2124
  • Fax:
Mailing address:
  • Phone: 616-690-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020691
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: