MEDICARE: DR. PATRICK RICHARD MCKNIGHT D.M.D

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
1	1223G0001X	General Practice Dentistry	3775	SC

General Provider Information

NPI Number	:	1164555108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK RICHARD MCKNIGHT D.M.D

Provider Business Mailing Address
First Line	:	1869 N. PARIS AVE.
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-2029
Country	:	US
Telephone Number	:	843-521-1869
Fax Number	:

Provider Business Practice Location Address
First Line	:	1869 N. PARIS AVE.
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-2029
Country	:	US
Telephone Number	:	843-521-1869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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