Provider Demographics
NPI:1275118572
Name:KNIEPKAMP, ALICIA BRIANNE (RDH)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:BRIANNE
Last Name:KNIEPKAMP
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1509
Mailing Address - Country:US
Mailing Address - Phone:618-580-5439
Mailing Address - Fax:
Practice Address - Street 1:1501 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1509
Practice Address - Country:US
Practice Address - Phone:618-580-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.014339124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL020.014339OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION