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General NPI Number Information
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NPI Number | 1720130230
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Entity Type | Organization
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Legal Business Name | KNOWLTON & MCFALL DENTISTRY, PLLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9161 SPARTA AVE NW
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City | SPARTA
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State | MI
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Zip | 49345-9405
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Country | US
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Telephone | 616-887-7389
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Fax | 616-887-7425
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | SPARTA
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State | MI
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Zip | 49345-0100
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Country | US
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Telephone | 616-887-7389
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Fax | 616-887-7425
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. ANDREW H. KNOWLTON
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Credential | DDS
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Telephone | 616-887-7389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17679
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License Number State | MI
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