Provider Demographics
NPI:1437463718
Name:KNOX, TIMOTHY DALE (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DALE
Last Name:KNOX
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 1:303 SOUTH GLENOAKS BLVD.
Mailing Address - Street 2:SUITE #8
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502
Mailing Address - Country:US
Mailing Address - Phone:818-846-1306
Mailing Address - Fax:
Practice Address - Street 1:303 SOUTH GLENOAKS BLVD.
Practice Address - Street 2:SUITE #8
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502
Practice Address - Country:US
Practice Address - Phone:818-846-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist