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General NPI Number Information
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NPI Number | 1124163779
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Entity Type | Organization
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Legal Business Name | ANNA KNAPP FAMILY DENTISTRY PA
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1041 JOHNNIE DODDS BLVD STE 4A
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City | MT PLEASANT
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State | SC
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Zip | 29464
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Country | US
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Telephone | 843-849-7609
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Fax | 843-849-7612
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Provider Business Mailing Address
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Address Line | 1041 JOHNNIE DODDS BLVD STE 4A
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City | MT PLEASANT
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State | SC
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Zip | 29464
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Country | US
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Telephone | 843-849-7609
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Fax | 843-849-7612
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. DONALD C RICKER
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Credential | DMD
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Telephone | 843-849-7609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3283
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License Number State | SC
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