Provider Demographics
NPI:1003895442
Name:KNOWLTON, DAVID K (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:KNOWLTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4788 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-3147
Mailing Address - Country:US
Mailing Address - Phone:801-969-4264
Mailing Address - Fax:801-969-2781
Practice Address - Street 1:4788 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-3147
Practice Address - Country:US
Practice Address - Phone:801-969-4264
Practice Address - Fax:801-969-2781
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1456361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice