Provider Demographics
NPI:1073685830
Name:KNIGHT, JEFFREY LAMONE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LAMONE
Last Name:KNIGHT
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 1:3105 SHAW DR.
Mailing Address - Street 2:P.O. BOX 550
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-0550
Mailing Address - Country:US
Mailing Address - Phone:228-497-3111
Mailing Address - Fax:228-497-3113
Practice Address - Street 1:3105 SHAW DR.
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553
Practice Address - Country:US
Practice Address - Phone:228-497-3111
Practice Address - Fax:228-497-3113
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS2876-951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660117Medicaid
MSMS2876-95OtherMISSISSIPPI DENTAL LICENS