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General NPI Number Information
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NPI Number | 1518251693
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Entity Type | Individual
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Provider Name | BRANDON KNOCKUM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 136 CARBONTON RD
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City | SANFORD
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State | NC
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Zip | 27330-4000
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Country | US
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Telephone | 919-718-5561
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Fax |
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Provider Business Mailing Address
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Address Line | 508 AUBURN SQUARE DR
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City | DURHAM
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State | NC
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Zip | 27713-8229
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Country | US
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Telephone |
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 9232
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License Number State | NC
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