Provider Demographics
NPI:1043505860
Name:KNAUER, MARSHALL JARED (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:JARED
Last Name:KNAUER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2663 SANDY PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4256
Mailing Address - Country:US
Mailing Address - Phone:770-977-0827
Mailing Address - Fax:770-973-6764
Practice Address - Street 1:2663 SANDY PLAINS RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4256
Practice Address - Country:US
Practice Address - Phone:770-977-0827
Practice Address - Fax:770-973-6764
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0142911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice