Provider Demographics
NPI:1083128003
Name:RICHARD D. KNOWLTON, DMD
Entity Type:Organization
Organization Name:RICHARD D. KNOWLTON, DMD
Other - Org Name:KNOWLTON DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:KNOWLTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD, MAGD, FICO
Authorized Official - Phone:717-367-1560
Mailing Address - Street 1:102 WEST HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2091
Mailing Address - Country:US
Mailing Address - Phone:717-367-1560
Mailing Address - Fax:717-367-8856
Practice Address - Street 1:102 W HIGH ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2019
Practice Address - Country:US
Practice Address - Phone:717-367-1560
Practice Address - Fax:717-367-8856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty