Provider Demographics
NPI:1003068396
Name:KNOTTS, CHANDRA (DDS)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:KNOTTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:340 WILLIAM AVE., STE 2
Mailing Address - City:DAVIS
Mailing Address - State:WV
Mailing Address - Zip Code:26260-0217
Mailing Address - Country:US
Mailing Address - Phone:304-259-5225
Mailing Address - Fax:
Practice Address - Street 1:217 WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:WV
Practice Address - Zip Code:26260-0217
Practice Address - Country:US
Practice Address - Phone:304-259-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 38381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice