Provider Demographics
NPI:1457495624
Name:KNUPPEL, DOROTHY ELLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:ELLAN
Last Name:KNUPPEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6106
Mailing Address - Country:US
Mailing Address - Phone:843-345-1220
Mailing Address - Fax:
Practice Address - Street 1:1040 5TH AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6106
Practice Address - Country:US
Practice Address - Phone:843-345-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 20751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC373338Medicaid