Provider Demographics
NPI:1134310063
Name:KNOEDLER, GEORGE A (DDS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:A
Last Name:KNOEDLER
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 1:1103 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455
Mailing Address - Country:US
Mailing Address - Phone:715-693-3255
Mailing Address - Fax:715-693-1466
Practice Address - Street 1:1103 PINE ST
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455
Practice Address - Country:US
Practice Address - Phone:715-693-3255
Practice Address - Fax:715-693-1466
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist