Provider Demographics
NPI:1376550178
Name:KNUTSON, KIRBY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:A
Last Name:KNUTSON
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 1:645 WOODGLEN PL NE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-1972
Mailing Address - Country:US
Mailing Address - Phone:507-455-1071
Mailing Address - Fax:507-444-0560
Practice Address - Street 1:315 18TH ST SE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4005
Practice Address - Country:US
Practice Address - Phone:507-451-2600
Practice Address - Fax:507-444-0560
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist