Provider Demographics
NPI:1437110350
Name:KNOWLES, HENRY A JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:A
Last Name:KNOWLES
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 KELSON AVE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2994
Mailing Address - Country:US
Mailing Address - Phone:850-526-3939
Mailing Address - Fax:850-526-3532
Practice Address - Street 1:4318 KELSON AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2994
Practice Address - Country:US
Practice Address - Phone:850-526-3939
Practice Address - Fax:850-526-3532
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice