Provider Demographics
NPI:1073633699
Name:KNUTSEN, NATHAN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:H
Last Name:KNUTSEN
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 1:5600 W BROWN DEER RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2346
Mailing Address - Country:US
Mailing Address - Phone:414-797-0328
Mailing Address - Fax:414-355-0242
Practice Address - Street 1:5600 W BROWN DEER RD
Practice Address - Street 2:SUITE 111
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2346
Practice Address - Country:US
Practice Address - Phone:414-797-0328
Practice Address - Fax:414-355-0242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist