Provider Demographics
NPI:1265511422
Name:KNELL, CRAIG (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:KNELL
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 49500
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-9500
Mailing Address - Country:US
Mailing Address - Phone:512-454-1220
Mailing Address - Fax:
Practice Address - Street 1:12416 HYMEADOW DRIVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2281
Practice Address - Country:US
Practice Address - Phone:512-258-3764
Practice Address - Fax:512-258-6348
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX22738122300000X, 390200000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist