Provider Demographics
NPI:1407069347
Name:KNUTH, JOAN KUTZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:KUTZ
Last Name:KNUTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10809 NW HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3179
Mailing Address - Country:US
Mailing Address - Phone:816-587-8177
Mailing Address - Fax:816-587-8324
Practice Address - Street 1:10809 NW HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3179
Practice Address - Country:US
Practice Address - Phone:816-587-8177
Practice Address - Fax:816-587-8324
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0134891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice