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General NPI Number Information
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NPI Number | 1306068192
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Entity Type | Individual
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Provider Name | KENT KNOERNSCHILD DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 1120 15TH STREET, GC-4200
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City | AUGUSTA
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State | GA
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Zip | 30912
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Country | US
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Telephone | 706-721-8813
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 15TH STREET, GC-4200
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City | AUGUSTA
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State | GA
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Zip | 30912
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Country | US
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Telephone | 706-721-8813
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Fax | 312-355-3864
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 019020381
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DNF000429
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License Number State | GA
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