Healthcare Provider Details

I. General information

NPI: 1114903606
Provider Name (Legal Business Name): SARA KATHLEEN KNOELL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S WASHINGTON AVE
HENDERSON TN
38340-2323
US

IV. Provider business mailing address

136 S WASHINGTON AVE
HENDERSON TN
38340-2323
US

V. Phone/Fax

Practice location:
  • Phone: 731-435-1253
  • Fax: 731-435-1254
Mailing address:
  • Phone: 731-435-1253
  • Fax: 731-435-1254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7951
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: