Healthcare Provider Details

I. General information

NPI: 1043309164
Provider Name (Legal Business Name): STEPHEN B. KNOFF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12330 120TH AVE NE
KIRKLAND WA
98034-6926
US

IV. Provider business mailing address

12330 120TH AVE NE
KIRKLAND WA
98034-6926
US

V. Phone/Fax

Practice location:
  • Phone: 425-821-7979
  • Fax: 425-821-0500
Mailing address:
  • Phone: 425-821-7979
  • Fax: 425-821-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number6821
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: