Healthcare Provider Details

I. General information

NPI: 1396895702
Provider Name (Legal Business Name): MICHAEL KNIGHT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VENSSA KNIGHT D.D.S.

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 WEST PINEBROOK ROAD SUITE #2000
PARK CITY UT
84098-5451
US

IV. Provider business mailing address

3080 WEST PINEBROOK ROAD SUITE #2000
PARK CITY UT
84098-5451
US

V. Phone/Fax

Practice location:
  • Phone: 435-649-6688
  • Fax: 435-649-0654
Mailing address:
  • Phone: 435-649-6688
  • Fax: 435-649-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number380199
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number363730
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number380199
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: