Healthcare Provider Details

I. General information

NPI: 1598443228
Provider Name (Legal Business Name): JARED KNIGHTON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 LACONIA RD
WINNISQUAM NH
03289
US

IV. Provider business mailing address

PO BOX 1020
WINNISQUAM NH
03289-1020
US

V. Phone/Fax

Practice location:
  • Phone: 603-528-1212
  • Fax:
Mailing address:
  • Phone: 603-528-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number04848
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number04848
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: