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General NPI Number Information
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NPI Number | 1801309265
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Entity Type | Organization
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Legal Business Name | KOENIGSKNECHT DENTISTRY PLLC
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 102 E CASS ST
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City | SAINT JOHNS
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State | MI
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Zip | 48879-1833
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Country | US
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Telephone | 989-224-2319
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Fax | 989-224-2144
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Provider Business Mailing Address
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Address Line | 102 E CASS ST
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City | SAINT JOHNS
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State | MI
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Zip | 48879-1833
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Country | US
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Telephone | 989-224-2319
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Fax | 989-224-2144
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | ERIN KOENIGSKNECHT
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Credential |
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Telephone | 989-224-2319
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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 | 2901020405
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901019112
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901011826
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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