Provider Demographics
NPI:1164849170
Name:KNOBLACH, DEAN (HAS)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:KNOBLACH
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 EAGLE WATCH BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3317
Mailing Address - Country:US
Mailing Address - Phone:727-480-1829
Mailing Address - Fax:
Practice Address - Street 1:2480 E BAY DR
Practice Address - Street 2:SUITE 17
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2467
Practice Address - Country:US
Practice Address - Phone:727-530-3533
Practice Address - Fax:727-535-5793
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS 4890237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist