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General NPI Number Information
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NPI Number | 1669691200
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Entity Type | Individual
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Provider Name | MICHAEL R KNOLL DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 2242 SANTA CLARA AVE
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City | ALAMEDA
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State | CA
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Zip | 94501-4417
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Country | US
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Telephone | 510-523-1862
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Fax | 510-521-1595
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Provider Business Mailing Address
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Address Line | 2242 SANTA CLARA AVE
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City | ALAMEDA
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State | CA
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Zip | 94501-4417
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Country | US
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Telephone | 510-523-1862
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Fax | 510-521-1595
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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 | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 30138
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN17902
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5224
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 48487
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | A128233
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License Number State | CA
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