Provider Demographics
NPI:1417070665
Name:KNODEL, ROBIN D (DDS)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:D
Last Name:KNODEL
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 1:4060 N MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3121
Mailing Address - Country:US
Mailing Address - Phone:262-639-7298
Mailing Address - Fax:
Practice Address - Street 1:4060 N MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-3121
Practice Address - Country:US
Practice Address - Phone:262-639-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice