MEDICARE: DR. JOEL CALEB KNUTSON D.D.S.

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	5001823 - 015	WI

General Provider Information

NPI Number	:	1982685947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL CALEB KNUTSON D.D.S.

Provider Business Mailing Address
First Line	:	PSC 3, BOX 127
Second Line	:
City	:	APO AP
State	:	OSAN AB
Zip	:	96266
Country	:	KR
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 3, BOX 127
Second Line	:
City	:	APO AP
State	:	OSAN AB
Zip	:	96266
Country	:	KR
Telephone Number	:	11-823-1661
Fax Number	:

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/21/2022

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