Provider Demographics
NPI:1235298753
Name:KNOEDLER, GERALD LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LOUIS
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 1:4879 LAVISTA RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8517
Mailing Address - Country:US
Mailing Address - Phone:770-938-5828
Mailing Address - Fax:770-938-6493
Practice Address - Street 1:4879 LAVISTA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8517
Practice Address - Country:US
Practice Address - Phone:770-938-5828
Practice Address - Fax:770-938-6493
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0069801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice