Healthcare Provider Details

I. General information

NPI: 1851372791
Provider Name (Legal Business Name): ROBERT MORRIS KNEPPER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/24/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENSINGTON GATE APT 214
GREAT NECK NY
11021-1229
US

IV. Provider business mailing address

1 KENSINGTON GATE APT 214
GREAT NECK NY
11021-1229
US

V. Phone/Fax

Practice location:
  • Phone: 516-297-1227
  • Fax: 516-829-5450
Mailing address:
  • Phone: 516-297-1227
  • Fax: 516-829-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number030859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: