Provider Demographics
NPI:1114592938
Name:KAW VALLEY FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:KAW VALLEY FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-290-0014
Mailing Address - Street 1:10601 KAW DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66111-1130
Mailing Address - Country:US
Mailing Address - Phone:913-441-3373
Mailing Address - Fax:
Practice Address - Street 1:10601 KAW DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66111-1130
Practice Address - Country:US
Practice Address - Phone:913-441-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty