Healthcare Provider Details

I. General information

NPI: 1316250608
Provider Name (Legal Business Name): JEFFREY CHRISTOPHER KNUDSON D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 GREENWOOD AVE N
SEATTLE WA
98103-3613
US

IV. Provider business mailing address

909 NE 45TH ST
SEATTLE WA
98105-4714
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-8223
  • Fax:
Mailing address:
  • Phone: 206-523-7180
  • Fax: 206-523-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60170676
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: