Provider Demographics
NPI:1043590425
Name:DAN KNECHTEL, DDS, PA
Entity Type:Organization
Organization Name:DAN KNECHTEL, DDS, PA
Other - Org Name:BLUE RIDGE PEDIATRIC DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNECHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-575-2345
Mailing Address - Street 1:218 ELKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2247
Mailing Address - Country:US
Mailing Address - Phone:828-575-2345
Mailing Address - Fax:864-575-2346
Practice Address - Street 1:218 ELKWOOD AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2247
Practice Address - Country:US
Practice Address - Phone:828-575-2345
Practice Address - Fax:864-575-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty