MEDICARE: DR. ANTHONY L KNOWLTON 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	122300000X	Dentist	CO9242	CO
2	1223G0001X	General Practice Dentistry	9242	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861588683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY L KNOWLTON DDS

Provider Business Mailing Address
First Line	:	317 S UNION AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-3429
Country	:	US
Telephone Number	:	719-564-5833
Fax Number	:	719-564-7097

Provider Business Practice Location Address
First Line	:	317 S UNION AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-3429
Country	:	US
Telephone Number	:	719-564-5833
Fax Number	:	719-564-7097

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	01/11/2022

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