MEDICARE: MS. CANDACE MARIE KNOEFLER DENTAL ASSISTANT

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	126800000X	Dental Assistant

General Provider Information

NPI Number	:	1962151050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CANDACE MARIE KNOEFLER DENTAL ASSISTANT

Provider Business Mailing Address
First Line	:	8089 HOLLYGRAPE LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8089 HOLLYGRAPE LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4039
Country	:	US
Telephone Number	:	719-526-5537
Fax Number	:

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

Provider Enumeration Date	:	03/23/2022
Last Update Date	:	01/27/2023

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