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General NPI Number Information
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NPI Number | 1841871845
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Entity Type | Organization
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Legal Business Name | KNUTSON FAMILY DENTAL
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 501 LUCAS LN
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City | ELLSWORTH
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State | WI
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Zip | 54011-2800
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Country | US
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Telephone | 715-523-9874
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Fax |
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Provider Business Mailing Address
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Address Line | N7536 COUNTY ROAD J
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City | BELDENVILLE
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State | WI
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Zip | 54003-5418
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Country | US
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Telephone | 715-523-9874
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. KAITLIN KNUTSON
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Credential | DDS
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Telephone | 715-523-9874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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