Healthcare Provider Details

I. General information

NPI: 1487797593
Provider Name (Legal Business Name): DR. MELVIN K. KNIGHT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 S 1300 E SUITE 3
SALT LAKE CITY UT
84105-3638
US

IV. Provider business mailing address

1955 S 1300 E SUITE 3
SALT LAKE CITY UT
84105-3638
US

V. Phone/Fax

Practice location:
  • Phone: 801-487-5807
  • Fax: 801-487-3438
Mailing address:
  • Phone: 801-487-5807
  • Fax: 801-487-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number128758
License Number StateUT

VIII. Authorized Official

Name: DR. JEFFREY S KNIGHT
Title or Position: DDS
Credential: DDS
Phone: 801-487-5807