Provider Demographics
NPI:1407899115
Name:KNIERIM, MICHAEL C (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:KNIERIM
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:PO BOX 467
Mailing Address - Street 2:805 MAIN
Mailing Address - City:PLEASANTON
Mailing Address - State:KS
Mailing Address - Zip Code:66075
Mailing Address - Country:US
Mailing Address - Phone:913-352-8503
Mailing Address - Fax:913-352-8440
Practice Address - Street 1:805 MAIN
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:KS
Practice Address - Zip Code:66075
Practice Address - Country:US
Practice Address - Phone:913-352-8503
Practice Address - Fax:913-352-8440
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1005548OtherHEALTH GUARD TILLE 21
KS116665OtherBCBS OF KS