Healthcare Provider Details

I. General information

NPI: 1881687283
Provider Name (Legal Business Name): JEFFREY COLLIER KNORR DDS, MSBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35050 23 MILE RD SUITE C
NEW BALTIMORE MI
48047-3606
US

IV. Provider business mailing address

50150 HEDGEWAY DR
SHELBY TWP MI
48317-1829
US

V. Phone/Fax

Practice location:
  • Phone: 586-725-2400
  • Fax: 586-725-2405
Mailing address:
  • Phone: 586-242-5721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901013088
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: