MEDICARE: DR. ALEXANDER KNOLD 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	122300000X	Dentist	63928	CA

General Provider Information

NPI Number	:	1851790323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER KNOLD D.M.D.

Provider Business Mailing Address
First Line	:	888 E DIVISADERO ST APT 206
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93721-1085
Country	:	US
Telephone Number	:	216-970-8251
Fax Number	:

Provider Business Practice Location Address
First Line	:	888 E DIVISADERO ST APT 206
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93721-1085
Country	:	US
Telephone Number	:	216-970-8251
Fax Number	:

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

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	08/20/2014

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