Provider Demographics
NPI:1154332450
Name:KNOPIK, TOD ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:ALAN
Last Name:KNOPIK
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 1:2930 HAMILTON BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2425
Mailing Address - Country:US
Mailing Address - Phone:712-255-1440
Mailing Address - Fax:712-277-8294
Practice Address - Street 1:2930 HAMILTON BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2425
Practice Address - Country:US
Practice Address - Phone:712-255-1440
Practice Address - Fax:712-277-8294
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA76811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice