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General NPI Number Information
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NPI Number | 1558091348
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL KNOLL DDS
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Gender | Male
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 764 CRESTVIEW DR
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City | REEDSBURG
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State | WI
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Zip | 53959-2581
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Country | US
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Telephone | 608-524-4213
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 HUNTINGTON PARK DR APT 2111
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City | REEDSBURG
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State | WI
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Zip | 53959-1471
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Country | US
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Telephone | 698-459-0071
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6000025-15
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License Number State | WI
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