Provider Demographics
NPI:1285817775
Name:FRED A. KNAYSI, D.D.S., P.C.
Entity Type:Organization
Organization Name:FRED A. KNAYSI, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNAYSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-282-6005
Mailing Address - Street 1:8921 THREE CHOPT RD
Mailing Address - Street 2:304
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4601
Mailing Address - Country:US
Mailing Address - Phone:804-282-6005
Mailing Address - Fax:804-282-3563
Practice Address - Street 1:8921 THREE CHOPT RD
Practice Address - Street 2:304
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4601
Practice Address - Country:US
Practice Address - Phone:804-282-6005
Practice Address - Fax:804-282-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005393302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization