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NPI Code Detail

MEDICARE: DR. QUENTIN KNUTSON DDS

MEDICARE: DR. QUENTIN KNUTSON DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric DentistD14206MN

General Provider Information

NPI Number : 1093277592
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. QUENTIN KNUTSON DDS
Provider Business Mailing Address
First Line : 2442 MOUNDS VIEW BLVD
Second Line :
City : SAINT PAUL
State : MN
Zip : 55112-1478
Country : US
Telephone Number : 763-355-8444
Fax Number :
Provider Business Practice Location Address
First Line : 2442 MOUNDS VIEW BLVD
Second Line :
City : SAINT PAUL
State : MN
Zip : 55112-1478
Country : US
Telephone Number : 763-316-5400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2019
Last Update Date : 12/09/2021

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