Provider Demographics
NPI:1164700670
Name:KNUDSON, ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:KNUDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 NE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4714
Mailing Address - Country:US
Mailing Address - Phone:065-237-1802
Mailing Address - Fax:
Practice Address - Street 1:909 NE 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4714
Practice Address - Country:US
Practice Address - Phone:206-523-7180
Practice Address - Fax:206-523-0323
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60237134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist