Healthcare Provider Details

I. General information

NPI: 1962419010
Provider Name (Legal Business Name): TREVOR ALAN KNOWLES D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/26/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N PROVIDENCE RD
COLUMBIA MO
65203-4365
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax: 573-442-5208
Mailing address:
  • Phone: 660-885-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2019003731
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: