Healthcare Provider Details

I. General information

NPI: 1265423065
Provider Name (Legal Business Name): KENNETH EUGENE KNOTT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CALLE DE NINOS
LAS CRUCES NM
88005-3293
US

IV. Provider business mailing address

PO BOX 13728
LAS CRUCES NM
88013-3728
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-5312
  • Fax: 575-526-5522
Mailing address:
  • Phone: 719-248-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD2599
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number100964
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: