MEDICARE: DR. FREDERICK ERNEST KNOLL 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
1	1223P0700X	Prosthodontics	DN5876	FL

General Provider Information

NPI Number	:	1710902929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK ERNEST KNOLL DDS

Provider Business Mailing Address
First Line	:	951 NE 167TH ST
Second Line	:	SUITE 208
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3711
Country	:	US
Telephone Number	:	305-651-0139
Fax Number	:	305-651-0152

Provider Business Practice Location Address
First Line	:	951 NE 167TH ST
Second Line	:	SUITE 208
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3711
Country	:	US
Telephone Number	:	305-651-0139
Fax Number	:	305-651-0152

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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